Management of inferior vena cava thrombosis after blunt liver injury

Abstract

Inferior vena cava (IVC) thrombosis after traumatic liver injury is an extremely rare condition, and only 12 cases have been reported in the English literature since 1911. We report a case of a 26-year-old man who presented with IVC thrombosis after blunt liver injury. IVC thrombosis was incidentally detected by computed tomography 15 days after conservative management of blunt liver injury. The patient denied any symptoms of thrombophlebitis and did not have any evidence of hypercoagulable state. We placed an IVC filter via the right jugular vein and started the anticoagulation treatment. The patient recovered successfully without operative treatment and IVC thrombosis disappeared completely two months later. We suggest that that the possibility of IVC thrombosis should be considered in patients with a large hematoma of the liver, which may cause compression of the IVC.

Traumatic Mesenteric Tear with Right Adrenal Haematoma and Partial Thrombosis of Inferior Vena Cava- A Rare Association

“…The clinical manifestations of IVC thrombosis have been described in the setting of complete thrombosis and include ascites, lower limb oedema/varicosities, features of Budd-Chiari syndrome and pulmonary embolism. [2,9] In our case, the thrombus was only small, eccentric and non-occlusive, so no specific clinical features of IVC thrombosis were seen. Also, no clinical evidence of pulmonary embolism was seen.…”

“…[5,6] Some cases have also been reported in association with hepatic or renal lacerations with extension of thrombus from hepatic or renal vein into the IVC. [7][8][9][10][11] In some cases, where there is no associated solid organ injury or retroperitoneal haematoma, endothelial and shearing injury have been postulated as the cause of venous thrombosis. [2,9] In our cases, there was hyperdense right adrenal haematoma with thrombosis of right adrenal vein and this thrombus was seen to extend directly into infrahepatic IVC causing its partial thrombosis.…”

“…It can prevent development progressive hepatic congestion and eventual hepatic failure. [9] More extensive thrombus, may require IVC reconstruction. Even endovascular thrombectomy and stent-grafting techniques have been described, but their long term management and prognosis is presently clear.…”

“…IVC filter has also been advocated to prevent pulmonary embolism which can be a potentially fatal complication of IVC thrombosis, especially in those with large floating thrombi and in those in which lung reserve is already compromised. [9,14] Medical treatment with anticoagulants can be used in patients with less extensive thrombus and in those in which surgical and endovascular treatment in not feasible. [9] It may not be possible to start anticoagulant treatment immediately due to associated other major injuries which dominate the clinical picture.…”

“…[9,14] Medical treatment with anticoagulants can be used in patients with less extensive thrombus and in those in which surgical and endovascular treatment in not feasible. [9] It may not be possible to start anticoagulant treatment immediately due to associated other major injuries which dominate the clinical picture. [3] In our case, due to mesenteric tear and segmental small bowel gangrene, immediate surgical intervention was undertaken to resect the gangrenous small bowel with end to end anastomosis.…”