An 18-year-old man with no morbid history was admitted on December 17, 2001, to the Emergency Unit of the Hospital Clínico Regional de Valdivia, 2 h after suffering a bullet wound in the epigastric region.
On examination, she was hemodynamically stable (70 mmHg, pulse 70 x'), oriented temporospatially, highlighting little bleeding and signs of peritoneal irritation, lumbar pain and epigastric wound resistance (BW).
Forty-five minutes after his arrival, he was admitted to the operating room with a diagnosis of complicated abdominal gunshot wound.
A supraumbilical midline laparotomy with hemoperitoneum of 2.5 l was performed, identifying an afractuous wound of the dome of the left hepatic lobe, which was partially bleeding.
She was admitted to the hospital with retrohepatic vena cava injury. An atriocaval shunt was performed, extending an incision to a lesser curvature, controlling the right laparotomy and establishing an orotracheal tube 7.5 through the atrium bleeding
Given the magnitude of the hepatic injury, a left hepatectomy was performed, as well as a transfixing lesion of the inferior vena cava, which was repaired with a 4/0 corrido prolene.
The packing of the bloody hepatic area, right pleural drains and closure was ruled out.
During surgery, 12 U red blood cells, 1,324 cc plasma and 10 l colloids and crystalloids were transfused.
He was admitted to the ICU hemodynamically stable, BP 139 mmHg, pulse 123 x', RR 21 x'.
The patient was connected to mechanical ventilation, which was maintained for 24 h, with intravascular coagulation, which required transfusion of cryoprecipitates, progressing favorably.
On December 20, 2001, the patient was readmitted to the operating room, performing peritoneal lavage and packing removal, with no evidence of bleeding.
On the 4th postoperative day (21/12/2001), the patient was discharged on the 29/12/01 day.
On 07/30/2004, both patients are performing their usual work activities without functional sequelae.
