Gonadal Vein Injury

Background. The following is a description of what we believe to be the first reported case of gonadal vein injury. Method. Retrospective review of a case report of a regional trauma center. Results. 35 year old female who sustained a right pelvic fracture after being hit by a sport utility vehicle while riding a bicycle. On arrival to the Level 1 Trauma Center, the patient was found to be hypotensive but responded to fluid therapy. CT of the abdomen and pelvis showed fractures of the right pubic ramus, bilateral hematomas and a small rim of low density around the inferior vena cava about the level of the right kidney, though the right renal vein, artery, and kidney functions were unremarkable. An emergent Inferior Vena Cavagram was performed revealing no acute abnormalities, however, secondary to the patient’s tachycardia and hypotension during the procedure, the patient was sent to the OR for exploratory laparotomy. In the operating room, after the retroperitoneum and pericaval areas were packed, the right gonadal vein was identified, and appeared to be bleeding in multiple sites due to a near-complete transection and avulsion of this vessel. The vessel was doubly ligated both proximally and distally. The patient’s blood pressure and heart rate improved after controlling the 34 bleed. Conclusion. Gonadal vein injuries can occur secondary to trauma and can produce significant bleeding which can be controlled by ligation of the vessel.