A PATIENT WITH HEPATIC INJURY OF TYPE IIIb WITH INJURY OF INFERIOR VENA CAVA ON POSTERIOR SURFACE OF THE LIVER WHO WAS SUCCESSFULLY SAVED BY RIGHT LOBECTOMY UNDER TOTAL HEPATIC VASCULAR EXCLUSION

This paper deals with a successful total hepatic vascular exclusion (THVE) for hepatic injury of IIIb+IVC according to the classification by the Japan Traumatic Association. A 19-year-old man in hemorrhagic shock state was transferred to the center after diagnosed as having hepatic injury of type IIIb due to a traffic accident at another hospital. While an aortic occlusion baloon catheter (AOBC) was inserted to maintain blood pressure, a laparotomy was performed. There existed asteroid rupture in the right hepatic lobe, and circulatory blockade at the hepatic hilar region was performed by means of Pringle method. When the right lobe was turned to resect the right lobe, massive venous bleeding from the posterior surface of the liver was found. Inferior vena cava (IVC) injury was suspected. IVC was interrupted at the top and bottom of the liver to make THVE, the IVC injury was repaired under non-hemorrhagic field, and a right lobectomy was performed. A total ischemic time came to 56 minutes, including 15 minutes for Pringle method alone and 41 minutes for continued THVE. No particular problems in hepatic function arose after the operation and the patient was discharged from the hospital on 22nd hospital day. As an adjuvant treatment for hepatic injury of IIIb+IVC, THVE associated with AOBC that can be done safely and easily appears to be of great value.