Today we had an interesting case. We came to the operating room and there was a young man waiting on a stretcher. He fell off his bicycle and landed on his machete. The wound penetrated his abdominal wall so we decided to operate. Once we got in the abdomen, we found there was a small amount of bleeding from behind the duodenum. All of a sudden, there was audible bleeding-the heart-stopping whoosh of blood pouring out of a large vein. The machete had lacerated the inferior vena cave just below the renal vein. There was a one inch hole in the sidewall of the cava.
We sewed up the laceration-then we changed our pants! The machete had practically skewered his entire body and there was also bleeding from the paraspinous muscles. We controlled all the remaining bleeding using FloSeal (Baxter) donated from Americares.
|Schematic showing access to the vena cava|