Korean J Hepatobiliary Pancreat Surg.  2002 Jun;6(1):107-110.

Treatment of Retrohepatic Caval Injury using Total Hepatic Vascular Isolation and Venovenous Bypass

• Lee KE
• Lee HJ
• Kim SB
• Kim SH
• Kim KS
• Her KH
• Suh KS
• Lee KU

Abstract

Retrohepatic caval injuries are a difficult problem to surgeons as its mortality approaching 50~80%. Several bypass techniques was advocated to reduce operative bleeding and to improve the prognosis of the traumatized patients. We successfully managed a case of retro hepatic caval injury using venovenous bypass and total hepatic vascular isolation. A 28 year old female patients was admitted to Cheju Medical Center injured in a traffic accident. At exploration, a retrohepatic caval injury was suspected. So patient was emergently transferred to Seoul National University Hospital, after gauze packing. On arrival, vital signs were stable. Reexploration was undertaken. There was gush out of blood from retrohepatic space. After clamping suprahepatic and infrahepatic vena cava, venovenous bypass was introduced to left axillary vein and left femoral vein using Biomedicus pump. Systemic heparinization was not used. Avulsion between vena cava and common trunk of left and middle hepatic veins was repaired and left hepatectomy was done. Gauze packing was done due to ongoing oozing by coagulopathy from massive transfusion. Total venovenous bypass time was 30 min. On 10th operative day, reexploration was undertaken to assure hemostasis and to remove packed gauze. On 54th postoperative day patient discharged without any morbidity.

Keyword

Liver trauma; Total hepatic vascular isolation; Venovenous bypass; Interhospital transfer

MeSH Terms

Accidents, Traffic
Adult
Axillary Vein
Constriction
Female
Femoral Vein
Hemorrhage
Hemostasis
Heparin
Hepatectomy
Hepatic Veins
Humans
Jeju-do
Mortality
Prognosis
Seoul
Vital Signs
Heparin