ABSTRACT
This article describes a case of abdominal trauma with laceration of the caudate lobe, avulsion of its short hepatic veins and tear of the inferior vena cava (IVC). Anatomic segmentectomy of I segment and direct suture of inferior cava vein was performed. On its arrival to the Emergency Department the patient was hemodynamically stable. Ultrasonography and CT scan demonstrated a fracture of I hepatic segment associated to a retroperitoneal haematoma. Because progressive anemia and unstable hemodynamic state, the patient was taken to the operating room for intervention. No postoperative complications due to surgery were reported. The patient left the hospital in XXII postoperative day, after normalization of clinical parameters.
Subject(s)
Liver/injuries , Liver/surgery , Humans , Male , Middle AgedABSTRACT
Traumatic diaphragmatic rupture is an uncommon but important problem in patients with multiple injuries. A retrospective analysis of 37 cases with diaphragmatic injuries, 34 of the left and 3 of the right hemidiaphragm, was carried out. Thirty-two patients were treated surgically during the acute phase and 5 after a variable delay post-trauma. Diagnostic problems are discussed, so also for comportance of a proper evaluation of chest films. Factors leading to a strong suspicion of diaphragmatic rupture in patients suffering from thoraco-addominal blunt trauma are emphasized in order to recognize diaphragmatic lesions. Finally, surgical treatment is considered. In most cases, laparotomy is the access route of choice, not only to achieve reduction of herniated viscera and repair of the diaphragmatic lesions, but also to treating the frequently associated intra-abdominal injuries. Whenever thoracotomy is required, it should always be performed via a separate incision.
