Acute Scrotal Edema as the Initial Presentation of Inferior Vena Cava Stenosis With Secondary Thrombosis After Right Hepatectomy: A Case Report.

Inferior vena cava (IVC) thrombosis is a rare complication after major hepatectomy. Delayed diagnosis may result in venous congestion, acute kidney injury, and other serious complications. A 57-year-old man underwent right hepatectomy for perihilar cholangiocarcinoma. On the second postoperative day, he developed oliguria, worsening renal function, and sudden scrotal swelling. Doppler ultrasonography showed preserved testicular perfusion with diffuse scrotal edema. CT angiography demonstrated partial thrombosis of the IVC just below the hepatic venous confluence, causing marked narrowing of venous flow. Emergency reoperation revealed mechanical stenosis of the IVC adjacent to the right hepatic vein stump. Thrombectomy was performed, and the narrowed segment was enlarged using an autologous parietal peritoneal patch. Renal function improved after surgery, urine output increased, and the scrotal edema resolved completely during follow-up. Sudden scrotal edema after hepatectomy may be the first clinical sign of IVC obstruction. Early imaging and prompt surgical treatment can prevent permanent renal and vascular complications.