Combined aortic and inferior vena cava injury

Abstract

Introduction: Combined injuries to the aorta and inferior vena cava are among the most severe traumatic injuries where mortality rates can approach 100%. Case Report: A 26­year­old male presented with multiple small caliber gunshot wounds to the right upper and lower back, right posterior arm and right gluteal area. He was diagnosed with large retroperitoneal hematoma on computed tomography (CT) scan. He underwent an exploratory laparotomy with exploration of a zone 1 retroperitoneal hematoma. An injury to the inferior vena cava (IVC) at the level of the left renal vein was identified and repaired by lateral venorrhaphy. Massive transfusion protocol (MTP) was activated. The patient was returned back to the operating room few hours later for recurrent bleeding. Aortic injury was identified one centimeter distal to the renal arteries secondary to ruptured pseudoaneurysm. The left renal vein was ligated for exposure. The aortic injury was repaired. The patient was resuscitated postoperatively and was discharged home without major morbidity. Conclusion: Combined inferior vena cava and infrarenal aortic injury carries a mortality of around 73%. All zone 1 retroperitoneal hematomas should be explored, with the exception of venous hematomas of the juxtahepatic vena cava. Mattox maneuver is the ideal exposure for a supramesocolic retroperitoneal hematoma and Cattell–Brash maneuver is used for inframesocolic retroperitoneal hematomas. Zone 1 retroperitoneal hematoma resulting from combined injuries to the inferior vena cava and aorta is highly lethal. Successful management requires early MTP, rapid and aggressive surgical management and application of elective vascular surgery techniques.