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| Year : 1986 | Volume
: 32
| Issue : 4 | Page : 229-30 |
Spontaneous tear of inferior vena cava (a case report).
Nair HT, Dalvi AN, Kulkarni HS, Shenoy SG
How to cite this article:
Nair H T, Dalvi A N, Kulkarni H S, Shenoy S G. Spontaneous tear of inferior vena cava (a case report). J Postgrad Med 1986;32:229 |
Incidence of tears of the inferior vena cava (IVC) due to injury is relatively small, out the mortality and morbidity associated with these injuries is high.[1] Recently, we had under our care, a case of inferior vena cava tear without any etiological factor. The rarity of the condition prompted us to present this report.
D.M., a 25 year old male patient was admitted in the emergency ward of K.E.M. Hospital at 2.00 A.M. in a state of shock. History obtained from relatives revealed that the patient only complained of dull aching pain in the back, not relieved by drugs. There was no history of rigorous exercises that evening. Past history of alcoholism, pain in abdomen in relation to food, haematemesis etc. was not elicitable. On admission, the patient was gasping with pulse non-palpable and blood pressure non-recordable and syanosis. He was immediately intubated and resuscitative measures were started. Bilateral abdominal paracentesis revealed no blood in the peritoneal cavity. As the patients condition deteriorated, he was subjected to surgery.
An emergency laparotomy with a midline incision was performed. The peritoneal cavity showed no evidence of blood; but the whole caecum and ascending colon alongwith the paracolic gutter were lifted off due to an underlying haematoma. After opening the right paracolic gutter, about 500 gm of clot along with bleeding was encountered. The kidneys and intestines were normal.
A linear tear, 1 cm long, located transversely on the anterior aspect of the inferior vena cava,3 cm below the orifices of renal veins was seen. The tear was sutured with 5/0 prolene with continuous interlocking stitches after achieving haemostasis by atraumatic clamps. The patient made an uneventful recovery in the initial postoperative period maintaining vital parameters adequately.
On the fifth post-operative day, the patient developed hypertension and oliguria which did not improve with diuretis. A renal venogram done showed a block of the renal vein. On the seventh post-operative day the patient deteriorated and was transferred to the artificial kidney dialysis unit where he eventually expired. Postmortem examination showed intact IVC suture line with a block of the right renal artery and vein .
Tears of IVC are usually due to blunt or penetrating trauma. These injuries can be lethal, mortality varying between 34% and 57%.[4] More than one third patients of IVC tear die before reaching the hospital and half of those admitted die despite resuscitation and early operation, usually because of exsanguination. Survival can be correlated with the time of admission, blood pressure and its response to fluid resuscitation.[2] Delivery of severely injured patients to trauma centres where resuscitation teams are available round the clock decreases the mortality and morbidity.[3] Mortality is lowest if the injury is restricted to infrarenal or suprarenal area.
We are thankful to the Dean. K.E.M. Hospital, Bombay for permitting us publish this report.
| 1. | Kudsk. K, A., Bongord, F. and Lim, R C. (Jr.): Determinants of survival after vena caval injury; analysis of 14 year experience. Arch. Surg., 119: 1009-1012, 1984.  |
| 2. | Ochsner, J. L., Crawford, E. S. and DeBakey. M, E.: Injuries of vena cava caused by external trauma.. Surgery . 49: 397-405, 1961, |
| 3. | Turpin. I,. State. D and Schwartz, A. Injuries to the inferior, vena cava and their management, Amer. J. Surg., 134: 5-32, 1977. |
| 4. | Wrichert, R . F, and. Hewitt. R. L.: Injuries to interior vena caves. Report of 35 cases. J. Trauma, 19: 649-657, 1970. |
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