Blunt injury to intrahepatic vena cava and hepatic veins with survival

Injuries to the intrahepatic vena cava and hepatic veins are extremely lethal, particularly when caused by blunt trauma. Repair of the vena cava and hepatic veins often will require liver resection before adequate exposure can be obtained. To prevent lethal hemorrhage during resection and vascular repair, total vascular isolation of the liver may be necessary. Anoxic injury under these circumstances may be minimized by local hypothermia. The two patients reported here were successfully treated by direct suture of the vascular injuries without hepatic resection; however, vascular isolation was utilized in one patient.