Palma Procedure for Acute Intraabdominal Major Venous Injury

We report a patient with multiple vascular injuries, including a ruptured anterior wall of inferior vena cava at the point of bifurcation, a ruptured anterior and posterior wall of left external iliac vein, ruptured urinary bladder and ligated left common iliac artery immediately proximal to the origin of internal iliac artery. These injuries were caused iatrogenically at the time of hysterectomy due to treat massive vaginal bleeding due to placenta previa and accreta. Due to the complexity of the injuries, a staged management was used in the treatment of this patient. First stage consisted of bleeding control and patient stabilization. Second stage of management consisted of definitive arterial and venous reconstruction by endovascular and vascular surgery intervention, which included a left femoral vein thrombectomy and a Palma procedure to restore venous drainage of the left extremity.