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.

1. IVC injury - A case report

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. IVC anatomy
PresenterDr. Hriday Ranjan Roy
Asst. Professor,
Surgery
Rangpur Medical
College, Rangpur.

4. CASE REPORT
IVC INJURY

5. Outline
anatomy
(from behind)

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. 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. Examination findings on
admission wereAppearance- restlessness, anemic.
Urine output- scanty
Pulse- rapid, thready and feeble.
B.P- non recordable

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. 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. 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. 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. 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. 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. Thorough
and
thorough
IVC injury

17. After
repair of
posterior
wall

18. After Repair of vena cava

19. 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.

20. 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.

21. Injury to posterior wall of stomach

23. Injury to anterior wall of stomach

24. 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.

25. 4 units of fresh blood were given
per-operatively. Injection calcium
gluconate and sodi bi carb was also
given.
Postoperative period was uneventful.

26. 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.

27. 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.

28. A huge swelling
occupying
epigastric, right
and left
hypochondriac
region persist
irrespective of
repeated
aspiration

29. 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.

30. The patient after complete cure
from his illness.

31. Patient is now stable and all of his
parameters are normal.
He is happy.
His happiness is valued trillion
dollars to us.

32. THANK
YOU
ALL