Penetrating injury to the inferior vena cava.
نویسندگان
چکیده
A 21-YEAR-OLD MALE PATIENT was admitted to the emergency department after a gunshot wound entering the right flank. The patient was in shock, with a blood pressure of 80/40 mmHg, 130 bpm heart rate, and a Glasgow Coma Scale of 10. We calculated an Injury Severity Score of 25 and Revised Trauma Score of 6,171. His breath sounds were normal. His initial base deficit was !12.4. No exit wound was visualized. The patient was taken to the operating room and underwent laparotomy, with a midline incision made. At celiotomy, a moderate amount of free intraperitoneal blood was evacuated. At this time, a large, expanding zone I retroperitoneal hematoma was found; exploration was performed after medial rotation of the right colon and duodenum. A large amount of blood was again evacuated. The bullet caused a large laceration in the infrarenal segment of the inferior vena cava (IVC; Fig); vascular control (distal and proximal) was obtained with the use of Satinsky clamps. Surprisingly, no other injuries were observed. Because the patient was critically ill, and primary repair was not amenable (because of the large gap), ligation of the IVC was performed. Fluid resuscitation and blood transfusion after surgery occurred in the intensive care unit. The patient died 20 hours later from the effects of prolonged shock and coagulopathy.
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عنوان ژورنال:
- Surgery
دوره 157 6 شماره
صفحات -
تاریخ انتشار 2015