[Repair of a suprahepaticocaval injury under extracorporeal circulation]

The case of a 29-year old man who presented with haemorrhage from hepatic veins and the retrohepatic vena cava is reported. On the belief that a conventional technique would be dangerous, total extracorporeal circulation was used as a supportive procedure. The method facilitated anatomic definition of the venous injuries. The repair could then be calmly and precisely carried out because of a practically bloodless operative field. The procedure was well tolerated and the postoperative course was uneventful; the patient was discharged 15 days later. Many surgical techniques have been described for the repair of traumatic injuries of the inferior vena cava and hepatic veins, but all with a high level of peroperative mortality. So, cardiopulmonary bypass and hypothermia seemed to be a useful procedure. However, some points need further consideration: heparin administration may promote bleeding from other lesions and, in the case of associated gastrointestinal injuries, the risk of major septic dissemination is great.