Simplified control of upper abdominal hemorrhage from the vena cava

Serious upper abdominal hemorrhage can be both frustrating and frightening. Most major vessels in the upper abdomen can be readily dealt with within the abdomen. The upper end of the inferior vena cava is an exception. Control above the liver, below the diaphragm, is difficult and hazardous. The maneuver described here for temporary occlusion within the pericardium is simple and safe. By its use and with control of the lower end at the appropriate level, the main vessel and/or its intrahepatic tributaries then can be approached under direct vision in a relatively bloodless field for safe, accurate ligation and/or reconstruction.