Inferior vena cava injuries: A case series and review of the South African experience

IntroductionPenetrating injury may involve the major vessels in the abdomen. Injury to the abdominal inferior vena cava (IVC) is uncommon and is usually caused by gunshot wounds. Mortality from IVC injuries is high and has changed little over time.AimThe aim of the study was to report a series of IVC injuries from an urban trauma unit and to compare this with reports from similar institutions.MethodA retrospective review of penetrating abdominal injuries at Kalafong Hospital from 1993 to 2010 was performed. All cases of injury to the IVC were retrieved and the following data recorded: patient demographics, incident history, origin of referral, description of the IVC injury, associated injuries, operative management, hospital stay and outcome. The results were compared to those from similar institutions.ResultsTwenty-seven patients with IVC injuries were treated. All were caused by gunshot wounds, and all had associated intra-abdominal injuries. The majority (56%) of injuries were infrarenal. The injury was managed most commonly by venorrhaphy and, when successful, all the patients survived. A third of patients with infrarenal injuries died, some after exploration of a stable peri-caval haematoma. Ten of the patients died (37%), half of them during surgery. These results are similar to those from similar institutions from earlier time periods.ConclusionsThis report concurs with other studies. IVC injury carries a high mortality rate and that this has not improved over several decades. Less aggressive management of some stable patients or stable injuries is proposed by the authors for possible improvement of the mortality rate.