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A Shrock shunt can be fashioned by using a cuffed endotracheal tube or a an intercostal drainage tube. This is especially useful if the retrohepatic IVC is injured. Basically a controlled incision is made via a purse string well below or above the tear and an endotracheal tube with a hole cut distally like an eye or an intercoastal drainage tube with an additional hole made distally is passed through the elective arteriotomy/ venotomy. The vessel is taped above and below the tear (in the case of an endotracheal tube taping can be avoided on the cuffed end). This now effectively isolates the torn area while allowing continued blood flow via the lumen of the tube allowing precise repair/ patching etc.

ReferencesEdit

1: Arch Surg. 1968 May;96(5):698-704.

Management of blunt trauma to the liver and hepatic veins.

Schrock T, Blaisdell FW, Mathewson C Jr.

PMID: 5647544 [PubMed - indexed for MEDLINE]

2: Ann Surg. 1988 May;207(5):555-68. [1]

The atriocaval shunt. Facts and fiction.

Burch JM, Feliciano DV, Mattox KL.

Cora and Webb Mading Department of Surgery, Baylor College of Medicine, Houston, TX 77030.

During the past 11 years, 31 patients with major juxtahepatic venous injuries were treated with the atriocaval shunt. Penetrating injuries occurred in 27 patients (87%), and injuries from blunt trauma occurred in four patients. Shock was present on admission in 28 patients (90%). Resuscitative thoracotomy for cardiovascular collapse was required in 13 patients (42%). Juxtahepatic venous injuries included the vena cava in 23 patients (74%) and the hepatic veins alone in five patients (16%). One patient had an isolated portal venous injury, and two patients died before their vascular injuries could be delineated. Technical problems related to the shunt occurred in seven patients. Most were related to delays in placement or problems encountered in obtaining vascular control of the suprarenal vena cava. Major hepatic resection was performed in 11 patients (35%). Twenty-five patients died of their injuries. No patient survived who required resuscitative thoracotomy, hepatic resection, or when technical problems with the shunt occurred. Six patients (19%) survived and were discharged from the hospital. All sustained gunshot wounds to the retro-hepatic vena cava. Four of the six survivors had serious postoperative complications, but none were related to the shunt. Major juxtahepatic venous injuries are highly lethal. The atriocaval shunt will permit the salvage of some patients where other methods are not possible. Avoidance of delay and alternative shunting techniques that eliminate difficult maneuvers may improve survival in the future.

PMID: 3377566 [PubMed - indexed for MEDLINE]

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