Abstract
The prognosis of hepatic rupture with an injury of the retrohepatic inferior vena cava (IVC) or hepatic vein is still desparate. Besides, the best adjunctive procedures of dealing with this type of injury is not delineated. In this paper, fourteen such cases experienced at the department were divided into three groups by applied adjunctive procedures; manual compression in 7 cases, clamping of IVC above and below the liver (clamp of IVC) in 4, and atrio-caval shunt (ACS) in 3, and compared for the operative death and it's cause. The mortality rate was 57% in those treated with manual compression, 75% in clamp of IVC, and 0% in ACS. Two of three survivors treated with manual compression were child cases. The expired cases died mainly from hemorrhagic shock in those treated with manual compression, and cardiac arrest probably due to decreased coronary flow in clamp of IVC. Accumulated cases experienced may not be enough to draw some conclusion, but we think that atrio-caval shunt may be the best adjunctive procedure, should the procedure appropriately be applied, and manual compression in child cases is effective because of easiness to approach the hepatic vein and retrohepatic IVC.
