Treatment of Retrohepatic Caval Injury using Total Hepatic Vascular Isolation and Venovenous Bypass
Kyu Eun Lee, M.D., Hyuk-Joon Lee, M.D., Sang Beom Kim,
M.D., Seong Hoon Kim, M.D., Kwang Sik Kim, M.D.1, Kyu Hee
Her, M.D.1, Kyung-Suk Suh, M.D. and Kuhn Uk Lee, M.D.
Department of Surgery, Seoul National University College of
Medicine, Seoul, Korea, *Department of Surgery, Cheju National
University College of Medicine, Jeju, Korea
Retrohepatic caval injuries are a difficult problem to surgeons as its mortality approaching 50 80%. Several bypass tech- niques was advocated to reduce operative bleeding and to improve the prognosis of the traumatized patients. We suc- cessfully 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 Cen- ter injured in a traffic accident. At exploration, a retrohepatic caval injury was suspected. So patient was emergently trans-
ferred to Seoul National University Hospital, after gauze pack- ing. On arrival, vital signs were stable. Reexploration was un- dertaken. 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 hepa- rinization 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 transfu- sion. Total venovenous bypass time was 30 min. On 10
th op- erative day, reexploration was undertaken to assure hemo- stasis and to remove packed gauze. On 54
th postoperative day patient discharged without any morbidity. (Korean J HBP Surg 2002;6:107-110)
Key Words: Liver trauma, Total hepatic vascular isolation, Venovenous bypass, Interhospital transfer
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