Transdiaphragmatic pericardial window approach for blunt suprahepatic inferior vena cava injury: a case report

Suprahepatic inferior vena cava (SHIVC) injuries from blunt trauma are exceptionally rare and nearly uniformly fatal, with reported mortality rates ranging from 70% to 90%. Traditional approaches require cardiopulmonary bypass or extensive thoracotomy, often unavailable in emergency trauma settings. We report successful management of SHIVC injury utilizing the transdiaphragmatic pericardial window (TDPW) technique. An 18-year-old man presented with hemorrhagic shock after a high-speed motorcycle collision. Emergency laparotomy revealed grade V splenic and renal injuries and an SHIVC laceration at the hepatic vein junction. Through an extended midline incision, a 10-cm diaphragmatic incision provided direct pericardial access, enabling SHIVC visualization and repair without sternotomy. Despite requiring staged operations and a 31-day course of continuous renal replacement therapy, the patient achieved complete recovery with preserved renal function. This case demonstrates that TDPW, although previously described for other indications, can be successfully adapted for life-threatening SHIVC injuries when conventional resources are unavailable.