INTRAOPERATIVE THROMBOSIS OF THE INFERIOR VENA-CAVA

A pre-term infant weighing 900 g, gestational age 25 weeks, developed an acute abdomen, Intravenous lines had been inserted previously in th e left (silasticcatheter) and right (24 G cannula) saphenous veins in the neonatal intensive care unit. During surgical exploration, a perfo ration of the terminal ileum was found. The operation consisted in par tial resection of the perforated ileum with an end-to-end anastomosis and a double-lumen colostomy. Major blood loss during the procedure ca used serious haemodynamic problems, Despite transfusion of erythrocyte (100 ml), thrombocytes (75 ml), and albumin (50 ml), the patient deve loped bradycardia and hypotension. Administration of atropine, adrenal ine, and calcium IV had no effect. The operation could be finished onl y with extrathoracic resuscitation. When the drapes were removed, livi d, swollen lower limbs raised the suspicion of an acute thrombosis of the inferior vena cava, After insertion of a 24 G IV cannula into a ve in of the right upper arm, the circulation stabilised after rapid tran sfusion of 40 ml blood and 25 ml thrombocytes and resuscitation was su ccessful, Paediatricians and anaesthesiologists must consider the risk of thrombosis of the vena cava. If venous lines in the lower limbs ar e not visible to the anaesthesiologist during the operation, venipunct ure of veins of an upper limb is recommended before starting the surgi cal procedure. Due to the high incidence of vena cava thrombosis cause d by central venous lines and the difficulty of peripheral venipunctur e in pre-termintanty, a safe venous line should be inserted if necessa ry by pre-operative venesection.