Case of Duplicate Inferior Vena Cava

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Duplicate inferior vena cava
Intraoperative finding of large amount of blood and ischemic terminal ileum about 5 centimeters from the ileocecal valve. (B) Limited right hemi-colectomy with primary anastomosis.

Incidental finding of inferior vena cava

This article describes the case of a patient with blunt abdominal trauma, which led to an incidental finding of a duplicate inferior vena cava. A 36-year-old man presented to the emergency after he got into a motor vehicle collision. On the patient’s arrival at the emergency, the ATLS protocol was followed. In addition, the patient was stable with a GCS score of 15.

The patient complained of the right flank and hip pain. The examination was consistent with the ‘seatbelt sign’, a clinical and radiological sign characterised by the presence of ecchymosis or abraded skin extending along the abdomen after a motor vehicle accident.

Investigations and findings

Doctors further advised focused assessment with sonography for trauma (FAST), which was negative. A CT was also performed subsequently which showed the presence of bilateral pre-nephritic fat in the abdomen with mesenteric fat. In addition, a small amount of free fluid was also evident in the right iliac fossa. The findings were consistent with a possible mesenteric injury. The findings were also significant for a duplicate inferior vena cava which was unrelated to the patient’s presentation.

Doctors admitted the patient for observation and conservative management. Similarly, further advised serial abdominal examinations. However, the patient was hemodynamically stable despite his complaint of lower-quadrant pain. He was put on a liquid diet. On the 5th day, he complained of increased severity of pain and was referred for a repeated CT. The CT was significant for interval thickening of the ileal loops wall. Moreover, incidentally revealed a duplicate inferior vena cava.

Other findings included a lack of wall enhancement in the ileum with sub-segmental ischemia. The distal ileal branch was poorly pacified and irregular. In addition, there was an evident increase in the amount of free fluid, with no evidence of free air.

Doctors referred the patient for an urgent laparotomy. The patient had an uneventful recovery and was discharged on the 13th postoperative day. The patient returned for a follow-up to the outpatient clinic.

Source: American Journal of Case Reports

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Dr. Aiman Shahab is a dentist with a bachelor’s degree from Dow University of Health Sciences. She is an experienced freelance writer with a demonstrated history of working in the health industry. Skilled in general dentistry, she is currently working as an associate dentist at a private dental clinic in Karachi, freelance content writer and as a part time science instructor with Little Medical School. She has also been an ambassador for PDC in the past from the year 2016 – 2018, and her responsibilities included acting as a representative and volunteer for PDC with an intention to make the dental community of Pakistan more connected and to work for benefiting the underprivileged. When she’s not working, you’ll either find her reading or aimlessly walking around for the sake of exploring. Her future plans include getting a master’s degree in maxillofacial and oral surgery, settled in a metropolitan city of North America.

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