Skip to main content Skip to main navigation menu Skip to site footer

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



Abstract

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.

 

Keywords: acute subdural hemorrhage inferior vena cava injury traumatic brain injury

References

  1. Dewan MC, Rattani A, Gupta S, Baticulon RE, Hung Y-C, Punchak M, et al. Estimating the global incidence of traumatic brain injury. J Neurosurg. 2019;130(4):1080–97. Available from: http://dx.doi.org/10.3171/2017.10.jns17352
  2. Gururaj G. Epidemiology of traumatic brain injuries: Indian scenario. Neurol Res. 2002;24(1):24–8. Available from: http://dx.doi.org/10.1179/016164102101199503
  3. GODLEWSKI B, PAWELCZYK A, PAWELCZYK T, CERANOWICZ K, WOJDYN M, RADEK M. Retrospective Analysis of Operative Treatment of a Series of 100 Patients With Subdural Hematoma. Neurol Med Chir (Tokyo). 2013;53(1):26–33. Available from: http://dx.doi.org/10.2176/nmc.53.26
  4. Hyder AA, Wunderlich CA, Puvanachandra P, Gururaj G, Kobusingye OC. The impact of traumatic brain injuries: A global perspective. NeuroRehabilitation. 2007;22(5):341–53. Available from: http://dx.doi.org/10.3233/nre-2007-22502
  5. Marmarou A, Lu J, Butcher I, McHugh GS, Murray GD, Steyerberg EW, et al. Prognostic Value of The Glasgow Coma Scale And Pupil Reactivity in Traumatic Brain Injury Assessed Pre-Hospital And on Enrollment: An IMPACT Analysis. J Neurotrauma. 2007;24(2):270–80. Available from: http://dx.doi.org/10.1089/neu.2006.0029
  6. Mehta N, Babu S, Venugopal K. An Experience with Blunt Abdominal Trauma: Evaluation, Management and Outcome. Clin Pract. 2014;4(2):34–7. Available from: http://dx.doi.org/10.4081/cp.2014.599
  7. Millikan JS, Moore EE. Critical factors in determining mortality from abdominal aortic trauma. Surg Gynecol Obstet. 1985;160(4):313–6.
  8. Cheaito A, Tillou A, Lewis C, Cryer H. Management of traumatic blunt IVC injury. Int J Surg Case Rep. 2016;28:26–30. Available from: http://dx.doi.org/10.1016/j.ijscr.2016.09.003
  9. Murray GD, Teasdale GM, Braakman R, Cohadon F, Dearden M, Iannotti F, et al. The European Brain Injury Consortium Survey of Head Injuries. Acta Neurochir (Wien). 1999;141(3):223–36. Available from: http://dx.doi.org/10.1007/s007010050292
  10. Ryan CG, Thompson RE, Temkin NR, Crane PK, Ellenbogen RG, Elmore JG. Acute traumatic subdural hematoma. J Trauma Acute Care Surg. 2012;73(5):1348–54. Available from: http://dx.doi.org/10.1097/ta.0b013e31826fcb30
  11. Tallon JM, Ackroyd-Stolarz S, Karim SA, Clarke DB. The epidemiology of surgically treated acute subdural and epidural hematomas in patients with head injuries: a population-based study. Can J Surg. 2008;51(5):339–45.
  12. Prahaladu P, Prasad KS, Rajasekhar B, Reddy KS. Clinical study of acute subdural haematoma – a level I trauma care centre experience. Int J Res Med Sci. 2017;5(3):857. Available from: http://dx.doi.org/10.18203/2320-6012.ijrms20170625
  13. Okyere I, Yorke J, Agbeko EA, Forson PK, Bonney J. Inferior vena cava injury: survival of a rare case. Ghana Med J. 2019;53(2):181. Available from: http://dx.doi.org/10.4314/gmj.v53i2.14
  14. MILLIKAN JS, MOORE EE, COGBILL TH, KASHUK JL. Inferior Vena Cava Injuries—A Continuing Challenge. J Trauma Inj Infect Crit Care. 1983;23(3):207–12. Available from: http://dx.doi.org/10.1097/00005373-198303000-00005
  15. Buckman RF, Pathak AS, Badellino MM, Bradley KM. Injuries of the inferior vena cava. Surg Clin North Am. 2001;81(6):1431–47. Available from: http://dx.doi.org/10.1016/s0039-6109(01)80016-5
  16. Huerta S, Bui TD, Nguyen TH, Banimahd FN, Porral D, Dolich MO. Predictors of Mortality and Management of Patients with Traumatic Inferior Vena Cava Injuries. Am Surg. 2006;72(4):290–6. Available from: http://dx.doi.org/10.1177/000313480607200402

How to Cite

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. https://doi.org/10.15562/bmj.v10i2.2393
ACM ACS APA ABNT Chicago Harvard IEEE MLA Turabian Vancouver
Download Citation
Endnote/Zotero/Mendeley (RIS) BibTeX

HTML
1

Total
15

Share

Search Panel

Marsal Risfandi
Google Scholar
Pubmed
BMJ Journal

Sayed Musyari
Google Scholar
Pubmed
BMJ Journal

Celia Celia
Google Scholar
Pubmed
BMJ Journal