Abdominal Vascular Injuries Clinical Presentation

Updated: Oct 06, 2016
  • Author: Stephen A Tonks, MD; Chief Editor: John Geibel, MD, DSc, MSc, AGAF  more...
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Presentation

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 unstable patients with positive results, including pericardial effusion, on focused assessment with sonography for trauma (FAST) or diagnostic peritoneal lavage (DPL) require surgery.

Hemodynamically stable blunt trauma patients who have peritoneal signs or positive computed tomography (CT) findings require exploration. 

Penetrating trauma

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.

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]

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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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