The role of cardiopulmonary bypass in the management of retrohepatic vena cava injury - A case report and review of the literature

Injuries to the retrohepatic vena cava are extremely rare and are associated with an operative mortality of up to 50% even in high volume trauma centres. We present a patient with such an injury who underwent successful repair using cardiopulmonary bypass and deep hypothermic circulatory arrest. A 23 year old male was transferred to our unit following laparotomy with packing of the abdomen after uncontrolled haemorrhage from the retrohepatic vena cava was experienced. The patient was placed on full cardiopulmonary bypass and cooled to 20 °C before clamping of the supracoeliac aorta and inferior vena cava. This facilitated exposure of the retrohepatic cava and allowed successful primary repair of a 5 cm laceration. Other techniques to allow repair of these injuries, such as atriocaval shunts and total vascular exclusion of the liver, are associated with a high mortality. We believe the technique described in this case report is an alternative strategy that can be used successfully to manage life threatening from the retrohepatic vena cava.