Vascular Trauma: Abdomen and Pelvis

Vascular Trauma: Abdomen and Pelvis

c40-fig-5001

Retroperitoneal (RP) Injuries


These are associated with a very high mortality and morbidity (including pancreatic, biliary and duodenal injuries), mostly due to massive haemorrhage. Management is dependent on which of the three distinct anatomical zones is involved (see Figure 40.1).


Investigation Versus Immediate Management



  • The decision to surgically manage RP injuries emergently or to investigate further is dependent on physiology at presentation.
  • If physiologically unwell, then immediate surgery is mandatory because of the high mortality from exsanguination.
  • Damage control surgery is often necessary to limit haemorrhage and to avoid physiologic and metabolic exhaustion.

Investigations



  • Bedside abdominal U/S. May rule in an intra-abdominal bleed, but is not sensitive for RP bleeding.
  • Contrast-enhanced CT scan. This is the most sensitive and specific investigation (arterial and portal venous phase).

Zone 1 RP Injury


Zone 1 haematoma (adjacent to the great vessels) on CT scanning or intra-operatively mandates further operative exploration!


Abdominal Aorta


This carries a very high mortality (>80%) with most dying before reaching hospital! Proximal control of the aorta can be performed via a transperitoneal (infrarenal) or supracoeliac approach (through the lesser sac). Although quickest for control, supracoeliac clamping >60 minutes in trauma has a near 100% mortality! If in extremis, proximal control should be via a left lateral thoracotomy. During surgery, the best exposure is with a left medial visceral rotation.

Only gold members can continue reading. Log In or Register to continue

Related posts:

  1. Vascular Investigations: Overview
  2. Raynaud’s and Cold Injury
  3. Peripheral Vascular Injury
  4. Angiography II: Access and Imaging

Stay updated, free articles. Join our Telegram channel
Tags:
Jul 1, 2016 | Posted by in CARDIOLOGY | Comments Off on Vascular Trauma: Abdomen and Pelvis

Full access? Get Clinical Tree
Get Clinical Tree app for offline access