Intra-Abdominal Vascular Trauma—A Need for Prompt Operation

Abstract

Prompt operative intervention to obtain vascular control is the most important factor in the treatment of intra-abdominal vascular injuries. In 81 patients with major abdominal vascular injuries, bullet wounds were the cause of injury in 51, stab wounds in 12, blunt trauma in 10, shotgun in 7, and 1 was an iatrogenic injury from insertion of a dialysis catheter. Twenty-nine of 81 patients died (35.8%). Twenty patients (70%) died of massive blood loss at operation or in the early postoperative period. Hypovolemic shock was the predominant distinguishing feature in the mortality group. The mortality rate increased with the increasing number of associated nonvascular injuries, ranging from 20% in patients without associated injuries to 100% in patients with 5 or more associated injuries. The mortality rate was increased with the number of vessels injured, ranging from 29% with 1 or 2 injured vessels to 100% with 4 or more. Late deaths occurred in 9 patients and were most commonly related to the complications of hypovolemic shock. In hospital settings where patients can be resuscitated in the operating room, prolonged stay in the emergency department for diagnostic and laboratory evaluation only delays the operative vascular control of exsanguinating hemorrhage.