Journal of Trauma and Injury

Original Article

Experience of surgical treatments for abdominal inferior vena cava injuries in a regional trauma center in Korea: Jin Woo Park, Dong Hun Kim; J Trauma Inj. 2023;36(2):105-113. Published online June 15, 2023; DOI: https://doi.org/10.20408/jti.2023.0001

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Abstract PDF: Purpose
Inferior vena cava (IVC) injuries are a rare type of traumatic abdominal injuries that are challenging to treat and have a very high mortality rate. This study described our experience with the surgical treatment of traumatic IVC injuries, and we investigated the demographics, clinical profiles, and surgical outcomes of cases at a regional trauma center.
Methods
Among the 16 patients who were treated for a traumatic IVC injury between January 2014 and March 2022, 14 underwent surgery. The surgical outcomes included overall mortality and 24-hour mortality, and we investigated the factors associated with these surgical outcomes. The 14 patients were divided into two groups according to the location of the IVC injury (retrohepatic IVC or higher vs. subhepatic IVC), and differences between the two groups were analyzed.
Results
A body mass index (BMI) >23.0 kg/m2 (P=0.046), an elevated serum lactate level (P=0.043), and a shorter operation time (P=0.016) were associated with overall mortality. A higher BMI (P=0.050), high serum lactate level (P=0.004), shorter operation time (P=0.005), and an injury at the retrohepatic IVC or higher level (P=0.031) were associated with 24-hour mortality. Younger age (P=0.028), higher BMI (P=0.005), an acidic pH (P=0.028), high lactatemia (P=0.012), a higher hemoglobin level (P=0.012), and shorter door-to-operating room time (P=0.028) were associated with injury at the retrohepatic IVC or higher level. Patients with subhepatic IVC injuries had a high rate of direct repair (75.0%) and a significantly lower 24-hour mortality rate (37.5%, P=0.031).
Conclusions
Subhepatic IVC injuries are easy to access and are usually treated with a direct repair method. Injuries at the retrohepatic IVC or higher level are difficult to treat surgically and require a systematic and multidisciplinary treatment strategy.; Summary

Case Report

Exercise-induced traumatic muscle injuries with active bleeding successfully treated by embolization: three case reports: Yoonjung Heo, Hye Lim Kang, Dong Hun Kim; J Trauma Inj. 2022;35(3):219-222. Published online September 28, 2022; DOI: https://doi.org/10.20408/jti.2022.0028

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1 Citations

Muscle injuries caused by indirect trauma during exercise are common. Most of these injuries can be managed conservatively; however, further treatment is required in extreme cases. Although transcatheter arterial embolization is a possible treatment modality, its role in traumatic muscle injuries remains unclear. In this case series, we present three cases of exercise-induced muscle hemorrhage treated by transcatheter arterial embolization with successful outcomes. The damaged muscles were the rectus abdominis, adductor longus, and iliopsoas, and the vascular injuries were accessed via the femoral artery during the procedures.

Summary

Citations

Citations to this article as recorded by

Thermal and Magnetic Dual-Responsive Catheter-Assisted Shape Memory Microrobots for Multistage Vascular Embolization
Qianbi Peng, Shu Wang, Jianguo Han, Chenyang Huang, Hengyuan Yu, Dong Li, Ming Qiu, Si Cheng, Chong Wu, Mingxue Cai, Shixiong Fu, Binghan Chen, Xinyu Wu, Shiwei Du, Tiantian Xu
Research.2024;[Epub] CrossRef

Original Article

Analysis of procedural performance after a pilot course on endovascular training for resuscitative endovascular balloon occlusion of the aorta: Sung Wook Chang, Dong Hun Kim, Dae Sung Ma, Ye Rim Chang; J Trauma Inj. 2023;36(1):3-7. Published online September 22, 2022; DOI: https://doi.org/10.20408/jti.2022.0022

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Abstract PDF: Purpose
As resuscitative endovascular balloon occlusion of the aorta (REBOA) is performed in an extremely emergent situation, achieving competent clinical practice is mandatory. Although there are several educational courses that teach the REBOA procedure, there have been no reports evaluating the impact of training on clinical practice. Therefore, this study is aimed to evaluate the effects of the course on procedural performance during resuscitation and on clinical outcomes.
Methods
Patients who were managed at a regional trauma center in Dankook University Hospital from August 2016 to February 2018 were included and were grouped as precourse (August 2016–August 2017, n=9) and postcourse (September 2017–February 2018, n=9). Variables regarding injury, parameters regarding REBOA procedure, morbidity, and mortality were prospectively collected and reviewed for comparison between the groups.
Results
Demographics and REBOA variables did not differ between groups. The time required from arterial puncture to balloon inflation was significantly shortened from 9.0 to 5.0 minutes (P=0.003). There were no complications associated with REBOA after the course. Mortality did not show any statistical difference before and after the course.
Conclusions
The endovascular training for REBOA pilot course, which uses a modified form of flipped learning, realistic simulation of ultrasound-guided catheter insertion and balloon manipulation, and competence assessment, significantly improved procedural performance during resuscitation of trauma patients.; Summary

Case Reports

Extraanatomic bypass grafting in a patient with an infected femoral defect caused by a rollover accident: a case report: Dae Sung Ma, Dong Hun Kim, Jae-Wook Ryu, Sung Wook Chang; J Trauma Inj. 2022;35(Suppl 1):S23-S26. Published online July 21, 2022; DOI: https://doi.org/10.20408/jti.2021.0005

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Abstract PDF: A 59-year-old male patient presented to the emergency department after a tractor rollover accident. His Injury Severity Score was 41 points. He had multiple pelvic bone fractures and a left common femoral artery injury with soft tissue loss. The injured arteries with skin defect were initially managed with endarterectomy and primary repair. However, the sepsis secondary to the infection from a skin defect became uncontrolled. The infected wound developed massive hemorrhage from the repaired arteries. Supportive measures were initiated to achieve hemostasis but unsuccessful. We performed an anastomosis with a prosthetic graft from the common iliac artery to the femoral artery above the knee, avoiding the wound through the lateral side of the anterior superior iliac spine. After revascularization, the patient recovered uneventfully. An extraanatomic graft reconstruction should be considered early when the autologous vein is unsuitable.; Summary

Dual repair of traumatic flank hernia using laparoscopic and open approaches: a case report: Yoonjung Heo, Dong Hun Kim; J Trauma Inj. 2022;35(1):46-50. Published online October 25, 2021; DOI: https://doi.org/10.20408/jti.2021.0008

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Abstract PDF Supplementary Material: Traumatic flank hernia (TFH) is rare and prone to recurrence, which makes appropriate treatment challenging. No current guidelines define the optimal timing and method of repair. Meanwhile, recent advances in laparoscopic techniques are reshaping the options for the treatment of TFH. A dual approach that utilizes both laparoscopic and open methods has not previously been reported. Herein, we present the successful treatment of TFH after blunt trauma. A 46-year-old male patient underwent elective herniorrhaphy on hospital day 3, in which laparoscopic implantation of a sublay mesh and extracorporeal implantation of an onlay mesh were performed. Such techniques may be appropriate and result in feasible outcomes in hemodynamically stable patients with large TFH who are strongly suspected of having bowel herniation or concomitant intraperitoneal injuries. Larger studies are needed to assess the long-term results.; Summary

Original Articles

Diagnostic and Therapeutic Laparoscopy for Abdominal Trauma: A Single Surgeon’s Experience at a Level I Trauma Center: Hancheol Jo, Dong Hun Kim; J Trauma Inj. 2021;34(4):248-256. Published online March 15, 2021; DOI: https://doi.org/10.20408/jti.2020.0081

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Abstract PDF: Purpose
Laparoscopy has various advantages over laparotomy in terms of postoperative recovery. The number of surgeons using laparoscopy as a diagnostic and therapeutic tool in abdominal trauma patients is increasing, whereas open conversion is becoming less common. This report summarizes a single surgeon’s experience of laparoscopy at a level I trauma center and evaluates the feasibility of laparoscopy as a diagnostic and therapeutic tool for abdominal trauma patients.
Methods
In total, 30 abdominal trauma patients underwent laparoscopy by a single surgeon from October 2014 to May 2020. The purpose of laparoscopy was categorized as diagnostic or therapeutic. Patients were classified into three groups by type of surgery: total laparoscopic surgery (TLS), laparoscopy-assisted surgery (LAS), or open conversion (OC). Univariate analysis was performed to determine the advantages and disadvantages.
Results
The mechanism of injury was blunt in 19 (63.3%) and penetrating in 11 patients (36.7%). Eleven (36.7%) and 19 patients (63.3%) underwent diagnostic and therapeutic laparoscopy, respectively. The hospital stay was shorter for patients who underwent diagnostic laparoscopy than for those who underwent therapeutic laparoscopy (5.0 days vs. 13.0 days), but no other surgical outcomes differed between the groups. TLS, LAS, and OC were performed in 12 (52.2%), eight (34.8%), and three patients (13.0%), respectively. There was no significant difference in morbidity and mortality among the three groups.
Conclusions
Laparoscopic surgery for selected cases of abdominal trauma may be feasible and safe as a diagnostic and therapeutic tool in hemodynamically stable patients due to the low OC rate and the absence of fatal morbidity and mortality.; Summary

An Early Experience of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) in the Republic of Korea: A Retrospective Multicenter Study: Joonhyeon Park, Sung Woo Jang, Byungchul Yu, Gil Jae Lee, Sung Wook Chang, Dong Hun Kim, Ye Rim Chang, Pil Young Jung; J Trauma Inj. 2020;33(3):144-152. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0051

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6 Citations

Abstract PDF

Purpose

This retrospective multicenter study analyzed trauma patients who underwent resuscitative endovascular balloon occlusion of the aorta (REBOA) in the Republic of Korea.

Methods

This study was conducted from February 2017 to May 2018 at three regional trauma centers in the Republic of Korea. The patients were divided into two groups (cardiopulmonary resuscitation [CPR] and No-CPR) for comparative analysis based on two criteria (complication and mortality) for logistic regression analysis (LRA).

Results

There were significant differences between the CPR and No-CPR groups in mortality (p=0.003) and treatment administered (p=0.016). By LRA for complications, total occlusion has significantly lesser risk than intermittent or partial occlusion in both univariate (odds ratio [OR] 0.06, 95% confidence interval [CI] 0.00-0.36, p=0.01) and multivariate (OR 0.05, 95% CI 0.00-0.38, p=0.01) analyses. The Rescue had a higher risk than the Coda or Reliant in univariate analysis (OR 4.91, 95% CI 1.14-34.25, p=0.05); however, it was not statistically significant in multivariate analysis (OR 6.98, 95% CI 1.03-74.52, p=0.07). By LRA for mortality, the CPR group was the only variable that had a significantly higher risk of mortality than the No-CPR group in both univariate (OR 17.59, 95% CI 3.05-335.25, p=0.01), and multivariate (OR 24.92, 95% CI 3.77-520.51, p=0.01) analyses.

Conclusions

This study was conducted in the early stages of REBOA implementation in the Republic of Korea and showed conflicting results from studies conducted by multiple institutions. Therefore, additional research with more accumulated data is needed.

Summary

Citations

Citations to this article as recorded by

Complications associated with the use of resuscitative endovascular balloon occlusion of the aorta (REBOA): an updated review
Marcelo Augusto Fontenelle Ribeiro Junior, Salman M Salman, Sally M Al-Qaraghuli, Farah Makki, Riham A Abu Affan, Shahin Reza Mohseni, Megan Brenner
Trauma Surgery & Acute Care Open.2024; 9(1): e001267. CrossRef
Contemporary Utilization and Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta for Traumatic Noncompressible Torso Hemorrhage in Korea: A Retrospective Multi-Center Study
Yoonjung Heo, Sung Wook Chang, Byungchul Yu, Byung Hee Kang, Pil Young Jung, Kyounghwan Kim, Dong Hun Kim
Journal of Acute Care Surgery.2024; 14(1): 16. CrossRef
On the Feasibility of Using REBOA Technology for the Treatment of Patients with Polytrauma
A. I. Zhukov, N. N. Zadneprovsky, P. A. Ivanov, L. S. Kokov
Russian Sklifosovsky Journal "Emergency Medical Ca.2024; 13(1): 14. CrossRef
Editor's Choice – Systematic Review and Meta-Analysis of Lower Extremity Vascular Complications after Arterial Access for Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA): An Inevitable Concern?
Megan Power Foley, Stewart R. Walsh, Nathalie Doolan, Paul Vulliamy, Morgan McMonagle, Christopher Aylwin
European Journal of Vascular and Endovascular Surg.2023; 66(1): 103. CrossRef
Early experience with resuscitative endovascular balloon occlusion of the aorta for unstable pelvic fractures in the Republic of Korea: a multi-institutional study
Dong Hun Kim, Jonghwan Moon, Sung Wook Chang, Byung Hee Kang
European Journal of Trauma and Emergency Surgery.2023; 49(6): 2495. CrossRef
Comparison between external fixation and pelvic binder in patients with pelvic fracture and haemodynamic instability who underwent various haemostatic procedures
Ji Young Jang, Keum Soek Bae, Byung Hee Kang, Gil Jae Lee
Scientific Reports.2022;[Epub] CrossRef

Case Reports

Effects of Resuscitative Endovascular Balloon Occlusion of the Aorta in Neurotrauma: Three Cases: Dong Hun Kim, Ye Rim Chang, Jung-Ho Yun; J Trauma Inj. 2020;33(3):175-180. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0047

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5 Citations

Abstract PDF

Resuscitative endovascular balloon occlusion of the aorta (REBOA) is widely performed as an adjunct to resuscitation or bridge to definitive control of non-compressible torso hemorrhage in patients with hemorrhagic shock. It is a crucial adjunct for the maintenance of cerebral and coronary perfusion during resuscitation. However, in polytrauma patients with concomitant neurotrauma, such as traumatic brain injury (TBI) or spinal cord injury, the physiological effects of REBOA are unclear. In this report on REBOA performed in a clinical setting for polytrauma patients with spinal cord injury or TBI, the physiological effects of REBOA in neurotrauma are reviewed.

Summary

Citations

Citations to this article as recorded by

Resuscitative Endovascular Balloon Occlusion of Aorta Versus Aortic Cross-Clamping by Thoracotomy for Noncompressible Torso Hemorrhage: A Meta-Analysis
Saad Khalid, Mahima Khatri, Mishal Shan Siddiqui, Jawad Ahmed
Journal of Surgical Research.2022; 270: 252. CrossRef
REBOA as a bridge to brain CT in a patient with concomitant brain herniation and haemorrhagic shock - A case report
Luca Bissoni, Emiliano Gamberini, Lorenzo Viola, Carlo Bergamini, Emanuele Russo, Giuliano Bolondi, Vanni Agnoletti
Trauma Case Reports.2022; 38: 100623. CrossRef
Transsplenic Ultrasound-Guided Balloon Positioning During a Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta: A Case Report
Yoonjung Heo, Sung Wook Chang, Dong Hun Kim
Journal of Acute Care Surgery.2022; 12(1): 34. CrossRef
Current Approaches to Resuscitative Endovascular Balloon Occlusion of the Aorta Use in Trauma and Obstetrics
Linden O. Lee, Paul Potnuru, Christopher T. Stephens, Evan G. Pivalizza
Advances in Anesthesia.2021; 39: 17. CrossRef
Damage control approach to refractory neurogenic shock: a new proposal to a well-established algorithm
Michael W Parra, Carlos Alberto Ordoñez, David Mejia, Yaset Caicedo, Javier Mauricio Lobato, Oscar Javier Castro, Juan Alfonso Uribe, Fernando Velasquez
Colombia Medica.2021; 52(2): e4164800. CrossRef

Priority Setting in Damage Control Surgery for Multiple Abdominal Trauma Following Resuscitative Endovascular Balloon Occlusion of the Aorta: Yoonjung Heo, Seok Won Lee, Dong Hun Kim; J Trauma Inj. 2020;33(3):181-185. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0040

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Abstract PDF Supplementary Material: Damage control surgery (DCS) is an abbreviated laparotomy procedure that focuses on controlling bleeding to limit the surgical insult. It has become the primary treatment modality for patients with exsanguinating truncal trauma. Herein, we present the case of a 47-year-old woman with liver, kidney, and superior mesenteric vein (SMV) injuries caused by a motor vehicle collision. The patient underwent DCS following resuscitative endovascular balloon occlusion of the aorta (REBOA). In this case report, we discuss the importance of priority setting in DCS for the treatment of multisystem damage of several abdominal organs, particularly when the patient has incurred a combination of major vascular injuries. We also discuss the implications of damage control of the SMV, perihepatic packing, and right-sided medial visceral rotation. Further understanding of DCS, along with REBOA as a novel resuscitation strategy, can facilitate the conversion of uniformly lethal abdominal injuries into rescuable injuries.; Summary

Review Article

Educational Simulation Videos for Performing Resuscitative Endovascular Balloon Occlusion of the Aorta: Sung Wook Chang, Dong Hun Kim, Ye Rim Chang; J Trauma Inj. 2020;33(3):140-143. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0035

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2 Citations

Abstract PDF Supplementary Material

Resuscitative endovascular balloon occlusion of the aorta (REBOA) has been accepted as an adjunct procedure for non-compressible torso hemorrhage in patients with hemorrhagic shock. With appropriate indications, REBOA should be performed for resuscitation regardless of the physician’s specialty. Despite its effectiveness in traumatized patients with hemorrhagic shock, performing REBOA has been challenging due to physicians’ lack of experience. Even though training in endovascular skills is mandatory, many physicians cannot undergo sufficient training because of the limited number of endovascular simulation programs. Herein, we share simulation video clips, including those of a vascular circuit model for simulation; sheath preparation; long guidewire and balloon catheter preparation; ultrasound-guided arterial access; sheath insertion or upsizing; and balloon positioning, inflation, and migration. The aim of this study was to provide educational video clips to improve physicians’ endovascular skills for REBOA.

Summary

Citations

Citations to this article as recorded by

Feasibility and Clinical Outcomes of Resuscitative Endovascular Balloon Occlusion of the Aorta in Patients with Traumatic Shock: A Single-Center 5-Year Experience
Gyeongho Lee, Dong Hun Kim, Dae Sung Ma, Seok Won Lee, Yoonjung Heo, Hancheol Jo, Sung Wook Chang
Journal of Chest Surgery.2023; 56(2): 108. CrossRef
Early experience with resuscitative endovascular balloon occlusion of the aorta for unstable pelvic fractures in the Republic of Korea: a multi-institutional study
Dong Hun Kim, Jonghwan Moon, Sung Wook Chang, Byung Hee Kang
European Journal of Trauma and Emergency Surgery.2023; 49(6): 2495. CrossRef

Case Report

Successful Damage Control Resuscitation with Resuscitative Endovascular Balloon Occlusion of the Aorta in a Pediatric Patient: Yoonjung Heo, Sung Wook Chang, Dong Hun Kim; J Trauma Inj. 2020;33(3):170-174. Published online September 30, 2020; DOI: https://doi.org/10.20408/jti.2020.0012

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Abstract PDF: Resuscitative endovascular balloon occlusion of the aorta (REBOA) is considered an emerging adjunct therapy for profound hemorrhagic shock, as it can maintain temporary stability until definitive repair of the injury. However, there is limited information about the use of this procedure in children. Herein, we report a case of REBOA in a pediatric patient with blunt trauma, wherein the preoperative deployment of REBOA played a pivotal role in damage control resuscitation. A 7-year-old male patient experienced cardiac arrest after a motor vehicle accident. After 30 minutes of cardiopulmonary resuscitation, spontaneous circulation was achieved. The patient was diagnosed with massive hemoperitoneum. REBOA was then performed under ongoing resuscitative measures. An intra-aortic balloon catheter was deployed above the supraceliac aorta, which helped achieved permissive hypotension while the patient was undergoing surgery. After successful bleeding control with small bowel resection for mesenteric avulsion, thorough radiologic evaluations revealed hypoxic brain injury. The patient died from deterioration of disseminated intravascular coagulation. Although the patient did not survive, a postoperative computed tomography scan revealed neither remaining intraperitoneal injury nor peripheral ischemia correlated with the insertion of a 7-Fr sheath. Hence, REBOA can be a successful bridge therapy, and this result may facilitate the further usage of REBOA to save pediatric patients with non-compressible torso hemorrhage.; Summary

Original Article

Quality Improvement in the Trauma Intensive Care Unit Using a Rounding Checklist: The Implementation Results: Ye Rim Chang, Sung Wook Chang, Dong Hun Kim, Jeongseok Yun, Jung Ho Yun, Seok Won Lee, Han Cheol Jo, Seok Ho Choi; J Trauma Inj. 2017;30(4):113-119. Published online December 30, 2017; DOI: https://doi.org/10.20408/jti.2017.30.4.113

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Abstract PDF: Purpose
Despite the numerous protocols and evidence-based guidelines that have been published, application of the therapeutics to eligible patients is limited in clinical settings. Therefore, a rounding checklist was developed to reduce errors of omission and the implementation results were evaluated.
Methods
A checklist consisting of 12 components (feeding, analgesia, sedation, thromboembolic prophylaxis, head elevation, stress ulcer prevention, glucose control, pressure sore prevention, removal of catheter, endotracheal tube and respiration, delirium monitoring, and infection control) was recorded by assigned nurses and then scored by the staff for traumatized, critically ill patients who were admitted in the trauma intensive care unit (ICU) of Dankook University Hospital for more than 2 days. A total of 170 patients (950 sheets) between April and October 2016 were divided into 3 periods (period 1, April to June; period 2, July to August; and period 3, September to October) for the analysis. Questionnaires regarding the satisfaction of the nurses were conducted twice during this implementation period.
Results
Record omission rates decreased across periods 1, 2, and 3 (19.9%, 12.7%, and 4.2%, respectively). The overall clinical application rate of the checklist increased from 90.1% in period 1 to 93.8% in period 3. Among 776 (81.7%) scored sheets, the rates of full compliance were 30.2%, 46.2%, and 45.1% for periods 1, 2, and 3, respectively. The overall mean score of the questionnaire regarding satisfaction also increased from 61.7 to 67.6 points out of 100 points from period 1 to 3.
Conclusions
An ICU rounding checklist could be an effective tool for minimizing the omission of preventative measures and evidence-based therapy for traumatized, critically-ill patients without overburdening nurses. The clinical outcomes of the ICU checklist will be evaluated and reported at an early date.; Summary

Case Reports

Isolated Traumatic Injury of the Pancreatic Head: A Case Report: Dong Hun Kim; J Trauma Inj. 2016;29(2):51-55. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.51

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Abstract PDF: Isolated injury to the pancreas after abdominal trauma is uncommon, and a delay in diagnosis and treatment can increase the morbidity and mortality. Therapeutic decisions with respect to pancreatic trauma are usually made based on the site of injury and the status of the pancreatic ductal system. In this report, we describe the surgical management of pancreatic head transection as an isolated injury following blunt abdominal trauma. A 55-year-old man presented with epigastric pain that radiated to the back. Abdominal computed tomography revealed a hematoma in the pancreatic head and upstream dilatation of the main pancreatic duct. Endoscopic retrograde cholangiopancreatography showed complete disruption of and contrast leakage from the main pancreatic duct in the pancreatic head region with a nonenhanced upstream duct. Emergency pancreaticoduodenectomy was successfully performed, and the patient was discharged on postoperative day 9 without any complications.; Summary

Management of Bile Leaks from Bilateral Intrahepatic Ducts after Blunt Trauma: Dong Hun Kim, Seokho Choi, Seung Je Go; J Trauma Inj. 2014;27(3):89-93.

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Abstract PDF: Bile leaks are complications that are much more frequent after a high-grade liver injury than after a low-grade liver injury. In this report, we describe the management of bile leaks that were encountered after angiographic embolization in a 27-year-old man with a high-grade blunt liver injury. He had undergone an abdominal irrigation and drainage with a laparotomy on post-injury day (PID) 16 due to bile peritonitis and continuous bile leaks from percutaneous abdominal drainage. He required three percutaneous drainage procedures for a biloma and liver abscesses in hepatic segments 4, 5 and 8, as well as endoscopic retrograde cholangiopancreatography with biliary stent placement into the intrahepatic biloma via the common bile duct. We detected communication between the biloma and the bilateral intrahepatic duct by using a tubogram. Follow-up abdominal computed tomography on PID 47 showed partial thrombosis of the inferior vena cava at the suprahepatic level, and the patient received anticoagulation therapy with low molecular weight heparin and rivaroxaban. As symptomatic improvement was achieved by using conservative management, the percutaneous drains were removed and the patient was discharged on PID 82.; Summary

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