Abdominal Vascular Injuries Clinical Presentation
- Author: Timothy H Pohlman, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, MA more...
Clinical data obtained from emergency medical services (EMS) can be crucial and may be the only patient information available. In inner city hospitals, GSWs and stab wounds predominate. Mechanism of injury, vital signs at the scene of the accident, and transit time are essential data. The amount of intravenous (IV) fluid the patient received in the field and during transport should also be elicited from EMS. Penetrating trauma to the chest below the nipple line should also be considered as penetrating trauma to the abdomen.
Patients without recorded vital signs at the scene of injury and blunt trauma victims without vital signs at the time of arrival in the emergency department (ED) rarely survive after resuscitation, with or without ED thoracotomy.
Hemodynamically stable blunt trauma patients who have peritoneal signs or positive computed tomography (CT) findings require exploration. Hemodynamically unstable patients with positive results, including pericardial effusion, on focused assessment with sonography for trauma (FAST) or diagnostic peritoneal lavage (DPL) require surgery.
Stable patients with posterior wounds and most patients with anterior stab wounds should be evaluated with triple-contrast (eg, oral, IV, rectal) CT scanning, diagnostic laparoscopy to exclude peritoneal penetration, and/or FAST examination to exclude hemoperitoneum. Patients with GSWs to the abdomen require celiotomy for evaluation and treatment, although some trauma surgeons prefer selective nonoperative evaluation of abdominal GSWs in stable patients.
Hemodynamically unstable patients should be transported immediately to the operating room (OR) if the airway is secure and ventilation is adequate, preferably within 5 minutes of arrival in the ED).
Early complications of abdominal vascular injuries include ongoing bleeding, coagulopathy, and abdominal compartment syndrome. Late complications include, but are not limited to, intra-abdominal infections, wound dehiscence, acute respiratory distress syndrome (ARDS), and pneumonia.
Fabian TC. Abdominal trauma including indications for celiotomy. Feliciano DV, Moore EE, Mattox KL, eds. Trauma. 3rd ed. Norwalk, Conn: Appleton and Lange; 1996. 441-59.
Morris JA Jr, Eddy VA, Rutherford EJ. The trauma celiotomy: the evolving concepts of damage control. Curr Probl Surg. 1996 Aug. 33(8):611-700. [Medline].
Ganter MT, Pittet JF. New insights into acute coagulopathy in trauma patients. Best Pract Res Clin Anaesthesiol. 2010 Mar. 24(1):15-25. [Medline].
Fikry K, Velmahos GC, Bramos A, et al. Successful selective nonoperative management of abdominal gunshot wounds despite low penetrating trauma volumes. Arch Surg. 2011 May. 146(5):528-32. [Medline].
Feliciano DV. Abdominal vascular injury. Feliciano DV, Moore EE, Mattox KL, eds. Trauma. 3rd ed. Norwalk, Conn: Appleton and Lange; 1996. 615-33.
Feliciano DV. Injuries to the great vessels of the abdomen. Wilmore DW, Cheung LY, Harken AH, Holcroft JW, Meakins JL, eds. Scientific American Surgery. New York, NY: Scientific American; 1996, revised 1998.
Vu M, Anderson SW, Shah N, Soto JA, Rhea JT. CT of blunt abdominal and pelvic vascular injury. Emerg Radiol. 2010 Jan. 17(1):21-9. [Medline].
Benjamin ER, Siboni S, Haltmeier T, Lofthus A, Inaba K, Demetriades D. Negative Finding From Computed Tomography of the Abdomen After Blunt Trauma. JAMA Surg. 2015 Dec 1. 150 (12):1194-5. [Medline].
Harding A. Blunt Trauma Patients May Be Discharged After Negative Abdomen CT. Reuters Health Information. Available at http://www.medscape.com/viewarticle/851568. September 28, 2015; Accessed: December 21, 2015.
Kimball EJ, Adams DM, Kinikini DV, Mone MC, Alder SC. Delayed abdominal closure in the management of ruptured abdominal aortic aneurysm. Vascular. 2009 Nov-Dec. 17(6):309-15. [Medline].
Ding W, Wu X, Pascual JL, Zhao K, Ji W, Li N, et al. Temporary intravascular shunting improves survival in a hypothermic traumatic shock swine model with superior mesenteric artery injuries. Surgery. 2010 Jan. 147(1):79-88. [Medline].
Vandromme MJ, Griffin RL, Kerby JD, McGwin G Jr, Rue LW 3rd, Weinberg JA. Identifying risk for massive transfusion in the relatively normotensive patient: utility of the prehospital shock index. J Trauma. 2011 Feb. 70(2):384-8; discussion 388-90. [Medline].
Doll D, Matevossian E, Kayser K, Degiannis E, Hönemann C. [Evisceration of intestines following abdominal stab wounds : Epidemiology and clinical aspects of emergency room management.]. Unfallchirurg. 2013 Jun 12. [Medline].
|Artery Injured||Vein Injured|
Primary named vessels of superior mesenteric
Vena cava (infrarenal)
|IV||Superior mesenteric (trunk)
|Vena cava (infrahepatic)|
|V||Aorta (suprarenal)||Vena cava (suprahepatic)
Vena cava (retrohepatic)
|* Grade I injury includes the following: No named superior mesenteric artery or superior mesenteric vein branches; nonnamed inferior mesenteric artery or inferior mesenteric vein branches; phrenic artery/vein; lumbar artery/vein; gonadal artery/vein; ovarian artery/vein; other nonnamed small arterial or venous structures requiring ligation.|