Emergency Department Thoracotomy for Intra-abdominal Exsanguination: A Case Report of Inferior Vena Cava Injury

Kuuskne M, Barbic D, Azzam MH and Nemeth J

McGill University Health Centre, Emergency Medicine Residency Program, Canada
McGill University Health Centre, Critical Care Fellowship Program, Canada
Department of Emergency Medicine, McGill University Health Centre, Canada

^*Correspondance to: Martin Kuuskne 

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Abstract:

Background: Emergency department thoracotomy (EDT) is a rare and potentially lifesaving procedure. Although the survival rate for EDT is generally low, there exist guidelines containing specific indications for its use in a subset of patients with penetrating traumatic injuries. Injury to the inferior vena cava and subsequent intra-abdominal exsanguination due to penetrating trauma is associated with a high mortality rate however the use of EDT for such injuries remains to be adequately investigated.Objectives: To review the indications for and use of EDT, especially in relation to penetrating abdominal injuries, and to discuss the natural history and progression of injuries to the inferior vena cava.Case Report: A 28-year-old male presented to the Emergency Department after sustaining a stab to the thoracoabdominal region. A focused assessment with sonography for trauma (FAST) was positive for intra-abdominal free fluid. The patient was found to be persistently hypotensive despite aggressive fluid resuscitation and massive transfusion. An EDT was preformed for suspected intraabdominal exsanguination and the patient was transferred to the operating room where he was treated for an extensive inferior vena cava laceration. After a complicated intensive care unit course, the patient ultimately survived with full preservation of neurologic function.Conclusion: The use of EDT is associated with a low rate of survival in penetrating abdominal trauma but its appropriate and timely use by emergency physicians can be lifesaving.

Keywords:

Emergency department thoracotomy; Inferior vena cava injury; Penetrating trauma

Cite the Article:

Kuuskne M, Barbic D, Azzam MH, Nemeth J. Emergency Department Thoracotomy for Intra-abdominal Exsanguination: A Case Report of Inferior Vena Cava Injury. Ann Clin Case Rep. 2016; 1: 1078.