Isolated infrarenal caval disruption secondary to minimal blunt trauma

Injuries to the inferior vena cava (IVC) are highly lethal and are usually associated with gunshot wounds. Blunt injury to the IVC is a rare entity that is usually located in the retrohepatic space. We present the case of an infrarenal caval disruption in a 9-year-old as a result of minimal blunt trauma. A computed tomography scan showed that the patient had a large retroperitoneal hematoma associated with IVC disruption and proximal thrombus just below the renal veins. There was no evidence of either arterial or other intra-abdominal injuries. The patient had a fall in hematocrit and abdominal tenderness prompting operative exploration. Before laparotomy, bilateral balloon occlusion devices were placed in both femoral veins. The patient was noted to have a total disruption of his IVC just above the origin of his iliac veins. The anterior two-third of the IVC was avulsed, thus leaving the posterior portion against the retroperitoneum. Given the patient's hemodynamic instability and amount of venous damage, the IVC was oversewn and a damage control operation was undertaken. The following day, the patient was brought back to the operating room for a second-look laparotomy and abdominal closure. A pathologic examination revealed a high-grade spindle cell sarcoma. Blunt injury to the IVC is a rare entity and its location outside of the retrohepatic space should alert the surgeon to a potential underlying malignant etiology.