Management of retrohepatic inferior vena cava injury during hepatectomy and an intravascular foreign body caused by surgical gauze migration: a case report.

We report a case involving a hepatocellular carcinoma with massive bleeding from a large (retrohepatic inferior vena cava) RHIVC laceration during laparoscopic posterior sectionectomy, complicated by the exceedingly rare migration of surgical gauze into the left pulmonary artery (LPA). Hemostasis was achieved by manual compression and two anchoring Prolene sutures at both ends of the laceration, allowing effective RHIVC wall approximation. Given the low central venous pressure during hepatectomy, edge approximation significantly reduced bleeding and improved repair visibility. Postoperative imaging showed the gauze was lodged in the LPA, constituting an intravascular foreign body (IFB). The gauze was successfully retrieved via endovascular intervention without additional complications. Anchoring sutures with manual compression may be a helpful technique for managing a large RHIVC injury, and endovascular retrieval may provide a safe alternative to reoperation for a large IFB.