Inferior Vena Caval ThrombosisAfter Traumatic Liver Injury

Abstract

We report here the case of a 35-year-old man who presented with inferior vena cava thrombosis (IVCT) after blunt hepatic trauma. The IVCT was incidentally detected by computed tomography (CT) 35 days after deep parenchymal suturing and suture approximation for liver lacerations. The patient denied any symptoms of thrombophlebitis. However, he had presented with significantly elevated values of FDP-D-dimer and a modest increase in plasminogen concentration, which indicated that he had been in a hypercoagulable and hypofibrinolytic state after the operation. He had not undergone any prophylactic anticoagulant therapy because of his concomitant subarachnoid hemorrhage and huge hepatic hematoma. The patient was treated with an emercy thrombectomy. Posttraumatic IVCT is extremely rare phenomenon. We should consider IVCT in patients with a severe hepatic injury, particularly if their coagulation system change into hypercoagulable and hypofibrinolytic state. Additionally, this case made us reflect on the treatment of traumatic liver injury.

Successful surgical treatment of chronic inferior vena caval thrombosis following blunt trauma

“…Based on a review of the literature, the mechanism is explained as: (1) endothelial injury of the caval wall with secondary thrombus formation 2-4,6-8 ; (2) caval stasis secondary to compression by a pericaval or retroperitoneal hematoma 5 ; (3) hepatic vein thrombosis after liver laceration extending into the IVC 1 ; or (4) a hypercoagulable state after major trauma. 2,4 Endothelial injury of the caval wall was a factor in most of the cases (six of eight cases, 75%); two of the cases were not accompanied by liver injury. In the present case, IVC endothelial injury is thought to be the mechanism, as the patient did not have retroperitoneal hematoma or hepatic vein thrombosis, and the pancreatic pseudocyst did not compress the IVC.…”

“…IVCT after blunt trauma is extremely rare, with only a few cases reported in the Englishlanguage literature. [1][2][3][4][5][6][7][8] All cases were reports of acute or subacute thromboembolism. This is the fi rst reported case of surgical treatment for chronic IVCT following blunt trauma.…”

Thrombectomy under Cardiopulmonary Bypass for Inferior Vena Cava Thrombosis Induced by Liver Injury

“…[2][3][4][5] The pathogenesis difficult to go on to remove the thrombus located in the retrohepatic IVC because venous return during the thrombectomy gradually increased and became uncontrollable. We needed a bloodless surgical field to adequately remove the thrombus in the retrohepatic IVC.…”

“…of IVCT associated with liver injury are generally occurs in the following manner: [2][3][4][5] (1) hepatic vein thrombosis, which extends into the IVC, (2) endothelial injury of the caval wall, (3) caval flow stasis caused by the compression with a pericaval or a retroperitoneal hematoma, and/ or (4) hypercoagulable and hypofibrinolytic state after major trauma. In our case, we speculated that the liver laceration and subsequent subcapsular hematoma provoked the thrombus formation in the middle hepatic vein, which gradually extended into the IVC during the course of one month.…”

Management of inferior vena cava thrombosis after blunt liver injury

“…Inferior vena cava (IVC) thrombosis after hepatic trauma is an extremely rare condition, and only 12 cases have been reported in the English literature since 1911. 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 Various mechanisms for the origin of this condition have been suggested; but there is no well-established evidence and treatment.…”