eMedicine Specialties > Trauma > Abdominal Trauma

Abdominal Vascular Injuries: Workup

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, Consulting Staff, Methodist Hospital, Clarian Health Partners Inc
Coauthor(s): H Scott Bjerke, MD, FACS, Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine, Medical Director of Trauma Services, Methodist Hospital, Clarian Health Partners, Inc; Aleksander R Komar, MD, Fellow, Section of Trauma and Critical Care, SUNY Stony Brook; Richard Fogler, MD, DS, FACS, Chair, Program Director, Department of Surgery, Division of Surgical Oncology, Brookdale University Hospital and Medical Center
Contributor Information and Disclosures

Updated: Apr 13, 2007

Workup

Imaging Studies

  • Hemodynamically stable patients with blunt trauma and suspected abdominal vascular injuries may benefit from abdominal CT scanning, which helps localize a hematoma and evaluate solid organ injuries.
  • Stable patients with stab wounds may undergo laparoscopy to confirm peritoneal penetration. If time permits, also perform chest and pelvic radiography to exclude bleeding into the chest and pelvic fracture.
  • Hemodynamically unstable patients with penetrating trauma should be transported immediately to the OR; no imaging studies are necessary. The assessment of hemodynamically unstable patients with blunt trauma to the abdomen may include FAST examination or DPL to confirm hemoperitoneum as well as portable chest radiography only if expeditious transport to the OR is not to be interrupted.

Diagnostic Procedures

  • In penetrating trauma, perform an abdominal exploration on most patients with a GSW to the abdomen.
  • Angiography with or without embolization may be considered in stable patients, particularly in patients with blunt trauma.

More on Abdominal Vascular Injuries

Overview: Abdominal Vascular Injuries
Workup: Abdominal Vascular Injuries
Treatment: Abdominal Vascular Injuries
Follow-up: Abdominal Vascular Injuries
Multimedia: Abdominal Vascular Injuries
References

References

  1. Boffard KD, Riou B, Warren B, et al. Recombinant factor VIIa as adjunctive therapy for bleeding control in severely injured trauma patients: two parallel randomized, placebo-controlled, double-blind clinical trials. J Trauma. Jul 2005;59(1):8-15; discussion 15-8. [Medline].

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

  3. DeBakey ME. Battle injuries of the arteries in WWII: an analysis of 2,471 cases. Ann Surg. 1946;123:534.

  4. Fabian TC. Abdominal trauma including indications for celiotomy. In: Trauma. 3rd ed. Appleton and Lange; 1996:441-59.

  5. Feliciano DV. Abdominal vascular injury. In: Trauma. 3rd ed. Appleton and Lange; 1996:615-33.

  6. Feliciano DV. Injuries to the great vessels of the abdomen. In: Wilmore DW, Cheung LY, Harken AH, Holcroft JW, Meakins JL, eds. Scientific American Surgery. New York: 1996, revised 1998.

  7. Feliciano DV, Burch JM, Spjut-Patrinely V, et al. Abdominal gunshot wounds. An urban trauma center's experience with 300 consecutive patients. Ann Surg. Sep 1988;208(3):362-70. [Medline].

  8. Jurkovich GJ, Hoyt DB, Moore FA, et al. Portal triad injuries. J Trauma. Sep 1995;39(3):426-34. [Medline].

  9. Morris JA, Eddy VA, Rutherford EJ. The trauma celiotomy: the evolving concepts of damage control. Curr Probl Surg. Aug 1996;33(8):611-700. [Medline].

  10. Pourmoghadam KK, Fogler RJ, Shaftan GW. Ligation: an alternative for control of exsanguination in major vascular injuries. J Trauma. Jul 1997;43(1):126-30. [Medline].

  11. Thal ER. Operative exposure of abdominal injuries and closure of the abdomen. In: Wilmore DW, Cheung LY, Harken AH, et al, eds. Scientific American Surgery. New York: 1996, revised 1997.

Further Reading

Keywords

abdominal hemorrhage, abdominal trauma, internal injury, internal injuries, gunshot wound, gun shot wound, GSW, stab wound, penetrating wound, motor vehicle accident, MVA, blunt trauma, blunt force trauma, midline supramesocolic hemorrhage, midline supramesocolic hematoma, midline inframesocolic hemorrhage, midline inframesocolic hematoma, lateral perirenal hemorrhage, lateral perirenal hematoma, lateral pelvic hemorrhage, lateral pelvic hematoma

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, Consulting Staff, Methodist Hospital, Clarian 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, and Surgical Infection Society
Disclosure: Nothing to disclose.

Coauthor(s)

H Scott Bjerke, MD, FACS, Clinical Associate Professor, Department of Surgery, Indiana University School of Medicine, Medical Director of Trauma Services, Methodist Hospital, Clarian Health Partners, Inc
H Scott Bjerke, MD, FACS is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Physician Executives, American College of Surgeons, American Medical Association, American Medical Informatics Association, Association for Academic Surgery, National Association of EMS Physicians, Pan-Pacific Surgical Association, Society of Critical Care Medicine, Southwestern Surgical Congress, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Aleksander R Komar, MD, Fellow, Section of Trauma and Critical Care, SUNY Stony Brook
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 and American Society of Abdominal Surgeons
Disclosure: Nothing to disclose.

Medical Editor

Ernest Dunn, MD, Program Director of General Surgery, Director of Trauma and Critical Care, Clinical Associate Professor, Department of Surgery, Methodist Hospitals of Dallas, University of Texas Southwestern
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, and Texas Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

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, and American College of Surgeons
Disclosure: Nothing to disclose.

CME Editor

Paolo Zamboni, MD, Professor of Surgery, Chief of Day Surgery Unit, Chair of Vascular Diseases Center, University of Ferrara, Italy
Paolo Zamboni, MD is a member of the following medical societies: American Venous Forum and New York Academy of Sciences
Disclosure: Nothing to disclose.

Chief Editor

John Geibel, MD, DSc, MA, Professor, Department of Surgery, Section of Gastrointestinal Medicine, and Department of Cellular and Molecular Physiology, Yale University School of Medicine; Director of Surgical Research, Department of Surgery, Yale-New Haven Hospital
John Geibel, MD, DSc, 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, and Society for Surgery of the Alimentary Tract
Disclosure: AMGEN Royalty Other; AMGEN Consulting fee Consulting

 
 
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