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Abdominal Vascular Injuries Clinical Presentation

  • Author: Timothy H Pohlman, MD, FACS; Chief Editor: John Geibel, MD, DSc, MSc, MA  more...
 
Updated: Dec 20, 2015
 

History

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.

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Physical Examination

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.

Blunt trauma

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.

Penetrating trauma

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.[5]

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).

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Complications

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.

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Contributor Information and Disclosures
Author

Timothy H Pohlman, MD, FACS Professor, Section of Trauma and Critical Care, Department of Surgery, Indiana University School of Medicine; Director, Surgical Critical Care, Methodist Hospital, Indiana University Health Partners, Inc

Timothy H Pohlman, MD, FACS is a member of the following medical societies: American College of Surgeons, Association for Academic Surgery, Society of University Surgeons, Surgical Infection Society

Disclosure: Nothing to disclose.

Coauthor(s)

H Scott Bjerke, MD, FACS Clinical Associate Professor, Department of Surgery, University of Missouri-Kansas City School of Medicine; Medical Director of Trauma Services, Research Medical Center; Clinical Professor, Department of Surgery, Kansas City University of Medicine and Biosciences

H Scott Bjerke, MD, FACS is a member of the following medical societies: American Association for the History of Medicine, American Association for the Surgery of Trauma, American College of Surgeons, Midwest Surgical Association, Royal Society of Medicine, Eastern Association for the Surgery of Trauma, Association for Academic Surgery, National Association of EMS Physicians, Pan-Pacific Surgical Association, Southwestern Surgical Congress, Wilderness Medical Society

Disclosure: Nothing to disclose.

Richard Fogler, MD, DS, FACS Chair, Program Director, Department of Surgery, Division of Surgical Oncology, Brookdale University Hospital and Medical Center

Richard Fogler, MD, DS, FACS is a member of the following medical societies: American College of Surgeons, American Society of Abdominal Surgeons

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Robert L Sheridan, MD Assistant Chief of Staff, Chief of Burn Surgery, Shriners Burns Hospital; Associate Professor of Surgery, Department of Surgery, Division of Trauma and Burns, Massachusetts General Hospital and Harvard Medical School

Robert L Sheridan, MD is a member of the following medical societies: American Academy of Pediatrics, American Association for the Surgery of Trauma, American Burn Association, American College of Surgeons

Disclosure: Received research grant from: Shriners Hospitals for Children; Physical Sciences Inc<br/>Received income in an amount equal to or greater than $250 from: SimQuest Inc -- consultant on burn mapping softwear ($1,500).

Chief Editor

John Geibel, MD, DSc, MSc, MA Vice Chair and Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director, Surgical Research, Department of Surgery, Yale-New Haven Hospital; American Gastroenterological Association Fellow

John Geibel, MD, DSc, MSc, MA is a member of the following medical societies: American Gastroenterological Association, American Physiological Society, American Society of Nephrology, Association for Academic Surgery, International Society of Nephrology, New York Academy of Sciences, Society for Surgery of the Alimentary Tract

Disclosure: Received royalty from AMGEN for consulting; Received ownership interest from Ardelyx for consulting.

Additional Contributors

Ernest Dunn, MD Program Director, Surgery Residency, Department of Surgery, Methodist Health System, Dallas

Ernest Dunn, MD is a member of the following medical societies: American College of Surgeons, American Medical Association, Association for Academic Surgery, Society of Critical Care Medicine, Texas Medical Association

Disclosure: Nothing to disclose.

Acknowledgements

The authors and editors of Medscape Reference gratefully acknowledge the contributions of previous author Aleksander R Komar, MD, to the development and writing of the source article.

References
  1. 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.

  2. Cox EF. Blunt abdominal trauma. A 5-year analysis of 870 patients requiring celiotomy. Ann Surg. 1984 Apr. 199(4):467-74. [Medline]. [Full Text].

  3. 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].

  4. Ganter MT, Pittet JF. New insights into acute coagulopathy in trauma patients. Best Pract Res Clin Anaesthesiol. 2010 Mar. 24(1):15-25. [Medline].

  5. 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].

  6. Feliciano DV. Abdominal vascular injury. Feliciano DV, Moore EE, Mattox KL, eds. Trauma. 3rd ed. Norwalk, Conn: Appleton and Lange; 1996. 615-33.

  7. 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.

  8. 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].

  9. Dayal M, Gamanagatti S, Kumar A. Imaging in renal trauma. World J Radiol. 2013 Aug 28. 5(8):275-84. [Medline]. [Full Text].

  10. Genovese EA, Fonio P, Floridi C, Macchi M, Maccaferri A, Ianora AA, et al. Abdominal vascular emergencies: US and CT assessment. Crit Ultrasound J. 2013 Jul 15. 5 Suppl 1:S10. [Medline]. [Full Text].

  11. 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].

  12. 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.

  13. 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].

  14. 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].

  15. 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].

  16. 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].

 
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Abdominal vascular injuries. Tangential gunshot injury to the inferior vena cava repaired by means of lateral venorrhaphy (arrow).
Table 1. American Association for the Surgery of Trauma Organ Injury Scale for Vascular Injuries
OIS



Grade*



Artery Injured Vein Injured
II Hepatic



Splenic



Gastric



Gastroduodenal



Inferior mesenteric



Primary named vessels of superior mesenteric



Splenic



Inferior mesenteric



III Renal



Iliac



Hypogastric



Superior mesenteric



Renal



Iliac



Hypogastric



Vena cava (infrarenal)



IV Superior mesenteric (trunk)



Celiac axis



Aorta (infrarenal)



Vena cava (infrahepatic)
V Aorta (suprarenal) Vena cava (suprahepatic)



Vena cava (retrohepatic)



Portal



Hepatic (extrahepatic)



* 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.
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