Acute subdural hemorrhage accompanied with rupture of the inferior vena cava: a case report

Marsal Risfandi, Sayed Musyari, Celia Celia

Marsal Risfandi
Neurosurgeon, Putri Bidadari Hospital, Langkat, Indonesia

Sayed Musyari
General surgeon, Putri Bidadari Hospital, Langkat, Indonesia

Celia Celia
Neurosurgeon, Atmajaya Hospital, Jakarta, Indonesia. Email: [email protected]
Online First: July 04, 2021 | Cite this Article
Risfandi, M., Musyari, S., Celia, C. 2021. Acute subdural hemorrhage accompanied with rupture of the inferior vena cava: a case report. Bali Medical Journal 10(2): 507-509. DOI:10.15562/bmj.v10i2.2393

Introduction: One of the main causes of mortality and morbidity with physical and mental disabilities is traumatic brain injury (TBI). Apart from that, TBI also causes huge socio-economic burdens around the world. About 60% of TBI cases reported are caused by traffic accidents. Acute subdural hemorrhage (ASDH) is the main clinical finding in TBI cases. Blunt abdominal trauma associated with TBI accounts for 14% of cases. Inferior vena cava (IVC) injury is the most common vessel injured in a blunt (0.6-1%) and penetrating abdominal trauma (0.5-5%). Injury of the IVC can lead to a very high mortality rate.

Case description: Male patient, 15 years old, presented to the emergency department 30 minutes after a traffic accident with decreased consciousness with the Glasgow Coma Scale score of 11. The patient’s chest was clear, abrasions were found on the left hypochondrium. Head CT scan represented acute subdural hemorrhage in the left frontotemporoparietal region was accompanied by midline shift more than 0,5cm. Hemicraniectomy decompression was performed. After decompression was done, the patient was unstable, blood pressure down to 70/50 mmHg and weak peripheral pulses with 140 beats per minute. Fluid and blood resuscitation have been performed but not responding. The patient remained hemodynamically unstable with minimal urine output. Physical examination reveals a tense abdomen. Diagnostic peritoneal lavage (DPL) was performed, blood was obtained. Exploration laparotomy was done by a midline incision, and IVC injury was found. The blood was removed, then packing on IVC with gauze, observation, and no blood comes out. The packing was opened, the patient stable, the operation was complete.

Conclusion: Case of severe head injury with acute SDH, then a craniectomy was performed, in the abdomen had a ruptured inferior vena cava, an exploratory laparotomy was done. Currently, the patient has recovered well without deficits.



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