CLINICAL CASES   

Chirurgia 2009 February;22(1):43-4

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Cervicomediastinal trauma of the subclavian-jugular confluence: surgical approach. Case report

Rodrigues A. S. L., Canelas A. L. C., De Oliveira M. V., Meguins L. C., Rolo D. F.

¹ Department of General SurgeryHospital de Pronto Socorro Municipal Dr. Humberto Maradei Pereira, Belém, Pará, Brazil 2 Division of Vascular Surgery Hospital de Pronto Socorro Municipal Dr. Humberto Maradei Pereira, Belém, Pará, Brazil 3 Faculty of Medicine Federal University of Pará, Belém, Pará, Brazil

Major venous trauma at the cervicomediastinal region is a life-threatening condition that has been challenging surgeons due to the technical difficulties in the surgical approach of the lesion. Subclavian-jugular venous confluence (SJC) injury is a rare situation with high mortality rates that requires aggressive treatment. In only a few situations, the combined approach with median sternotomy, cervicotomy and claviculectomy is necessary for adequate exposure of the SJC allowing repair of traumatic injuries and vacular control. We report on a 31 years-old man presenting an exsanguinating wound at neck zone I due to a traumatic injury against a car’s door. The patient arrived hemodynamically stable at the emergency department and underwent surgical exploration through median sternotomy, cervicotomy and right claviculectomy. During surgery, an extensive rupture of the SJC was identified and ligation of both veins was performed. The patient had an uneventful recovery, except for a mild edema on the right arm. This case reinforces that vascular control of the SJC injuries can be achieved by standard methods, such as ligation. However, appropriate access of the injure site requires an adequate exposure of the hemorrhage and oblique neck incision extended to a median sternotomy with resection of the clavicle gives the surgeon a better control of the procedure, which makes it the incision of choice in this case.