IVC injury - A case report
Penetrating abdominal
assault causing IVC injury- A
case report.
Organized by- Department of

Surgery, Rangpur Medical
Col...
IVC anatomy
PresenterDr. Hriday Ranjan Roy
Asst. Professor,
Surgery
Rangpur Medical
College, Rangpur.
CASE REPORT
IVC INJURY
Outline
anatomy
(from behind)
Mr Hafizur Rahman, aged 28 years
hailing from Gangachara, Rangpur
was admitted into this hospital on 5
January 2010 having...
On admissionHe was restlessness and his cloths
were stained with profuse blood.
Continuous oozing of blood through
the wou...
Examination findings on
admission wereAppearance- restlessness, anemic.
Urine output- scanty
Pulse- rapid, thready and fee...
Rapid resuscitation was tried by I/V
fluid and blood transfusion. But the
result of resuscitation was failed.
There was co...
At 7.30 pm, abdomen was opened by
a generous right paramedian
incision. The whole peritoneal cavity
was full of clotted an...
An injury on stomach at its antral part
and blood stained lesser sac - which
was full of blood draw the attention.
So, les...
There was terrible bleeding like a
igneous of volcano through an injury
at the site of body and head of the
pancreas media...
Keeping it controlled by an assistant,
duodenum was kocherized from
laterally and the IVC was explored.
The injury was fou...
Meticulous dissection of IVC was done
and control taken by rubber catheter
both above and below of the injury.
There was a...
Thorough
and
thorough
IVC injury
After
repair of
posterior
wall
After Repair of vena cava
Both were repaired by 5/0 prolene.
Control was removed. During these
procedure, only carotid pulse was
recorded by anesthe...
There was also associated injury to the
stomach injuring both anterior and
posterior wall near its antral part.
Both were ...
Injury to posterior wall of stomach
Injury to anterior wall of stomach
Nothing was done for the associated
pancreatic injury.
Two drain, one in pelvis and another in
lesser sac (through foramen...
4 units of fresh blood were given
per-operatively. Injection calcium
gluconate and sodi bi carb was also
given.
Postoperat...
At 5th post operative day, a cystic
swelling began to appear in left
hypochondriac region which was
gradually enlarging oc...
Patient also had respiratory distress.
Aspiration was done by wide bore
needle by which the patient felt
comfort. The aspi...
A huge swelling
occupying
epigastric, right
and left
hypochondriac
region persist
irrespective of
repeated
aspiration
After 5/6 monthsA 2nd operation was done for pseudopancreatic cyst by posterior cystogastrostomy.
Improvement was excellen...
The patient after complete cure
from his illness.
Patient is now stable and all of his
parameters are normal.
He is happy.

His happiness is valued trillion
dollars to us.
THANK
YOU
ALL
Inferior Vena Caval Injury - A case report
Inferior Vena Caval Injury - A case report
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Inferior Vena Caval Injury - A case report

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This patient's shock was reluctant to resuscitation by I/V fluids, blood transfusion and all sorts of effort. I opened his abdomen with taking double bond consent. So he was saved. Thanks God.

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Inferior Vena Caval Injury - A case report

  1. 1. IVC injury - A case report
  2. 2. Penetrating abdominal assault causing IVC injury- A case report. Organized by- Department of Surgery, Rangpur Medical College Hospital. Presenter- Dr. Hriday Ranjan roy, Asst. Professor (Surgery)
  3. 3. IVC anatomy PresenterDr. Hriday Ranjan Roy Asst. Professor, Surgery Rangpur Medical College, Rangpur.
  4. 4. CASE REPORT IVC INJURY
  5. 5. Outline anatomy (from behind)
  6. 6. Mr Hafizur Rahman, aged 28 years hailing from Gangachara, Rangpur was admitted into this hospital on 5 January 2010 having history of stab injury on right upper abdomen. Assault on him was occurred at 10 am and he reached hospital at 1.30 pm on the same day.
  7. 7. On admissionHe was restlessness and his cloths were stained with profuse blood. Continuous oozing of blood through the wound. Omentum came out through it.
  8. 8. Examination findings on admission wereAppearance- restlessness, anemic. Urine output- scanty Pulse- rapid, thready and feeble. B.P- non recordable
  9. 9. Rapid resuscitation was tried by I/V fluid and blood transfusion. But the result of resuscitation was failed. There was continuous oozing of fresh blood through the stab wound. So, the patient was submitted for urgent laparotomy with double risk bond consent.
  10. 10. At 7.30 pm, abdomen was opened by a generous right paramedian incision. The whole peritoneal cavity was full of clotted and fresh blood. It was sucked out and mopped out rapidly ( about 2/3 liters ). But continuous severe exsanguinations of blood made the field so difficult to identify the injury.
  11. 11. An injury on stomach at its antral part and blood stained lesser sac - which was full of blood draw the attention. So, lesser sac was accessed rapidly by opening the gastrocolic ligament.
  12. 12. There was terrible bleeding like a igneous of volcano through an injury at the site of body and head of the pancreas medial to duodenal C-cap. Pressure by mop failed to control the bleeding. So, manual finger pressure (introducing finger to the injury) was applied and it was controlled.
  13. 13. Keeping it controlled by an assistant, duodenum was kocherized from laterally and the IVC was explored. The injury was found extended up to vertebral column injuring both anterior and posterior wall of IVC.
  14. 14. Meticulous dissection of IVC was done and control taken by rubber catheter both above and below of the injury. There was about 1 inch linear longitudinal injury in both anterior and posterior aspect of IVC in its suprarenal part.
  15. 15. Thorough and thorough IVC injury
  16. 16. After repair of posterior wall
  17. 17. After Repair of vena cava
  18. 18. Both were repaired by 5/0 prolene. Control was removed. During these procedure, only carotid pulse was recorded by anesthesiologist. After removal of control, pulse, B.P and urine output began to reappear. Oozing from pre-vertebral area was controlled by cauterization. The renal and gonadal veins were found to be intact.
  19. 19. There was also associated injury to the stomach injuring both anterior and posterior wall near its antral part. Both were repaired by double layered suture.
  20. 20. Injury to posterior wall of stomach
  21. 21. Injury to anterior wall of stomach
  22. 22. Nothing was done for the associated pancreatic injury. Two drain, one in pelvis and another in lesser sac (through foramen of Winslow) were inserted. Closure of incision wound and stab wound was done accordingly. Recovery from anesthesia was uneventful.
  23. 23. 4 units of fresh blood were given per-operatively. Injection calcium gluconate and sodi bi carb was also given. Postoperative period was uneventful.
  24. 24. At 5th post operative day, a cystic swelling began to appear in left hypochondriac region which was gradually enlarging occupying the left hypochondriac, epigastria, umbilical and left lumber region. An ultrasonogram was done ( 13/ 01/2010 ) and report reveals huge encysted thick (infected) collection in upper abdomen.
  25. 25. Patient also had respiratory distress. Aspiration was done by wide bore needle by which the patient felt comfort. The aspirate was clear pancreatic fluid. Later on a folley catheter was inserted into the cyst by local anesthesia. Initially, about 1 to 11/2 liter of collection per 24 hours was there. But it was not responding to any conservative measure.
  26. 26. A huge swelling occupying epigastric, right and left hypochondriac region persist irrespective of repeated aspiration
  27. 27. After 5/6 monthsA 2nd operation was done for pseudopancreatic cyst by posterior cystogastrostomy. Improvement was excellent. We could do this operation at 1st setting, but his general condition was so grave to cope further lengthening of anesthesia periods.
  28. 28. The patient after complete cure from his illness.
  29. 29. Patient is now stable and all of his parameters are normal. He is happy. His happiness is valued trillion dollars to us.
  30. 30. THANK YOU ALL

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