DOI: http://dx.doi.org/10.18203/2349-2902.isj20205385

Near-transection of abdominal aorta due to stab injury: a case report

Suhas S. Bilchod, Nawaz M. Dakhani, Deepak Arkalgud, Yamanur P. Lamani

Abstract


Abdominal vascular injuries are amongst the most lethal injuries encountered by modern day trauma and vascular surgeons. Penetrating injuries to aorta have a wide spectrum of presentation mortality being 50-70%. 38-year-old male presented to emergency department with stab injury to abdomen with a knife stuck in-situ. Patient was conscious with herniating bowel loops from stab site. Bilateral limbs had good pulsations and no neurological deficit. Patient was taken for emergency laparotomy and found to have complete jejunal transection with near transection of aorta with knife stuck in the vertebra. Primary repair of aorta was done with prolene 5-0 along with jejuno-jejunal anastomosis. Patient was transfused with 12 units of blood and 8 units of FFP. Postoperatively patient recovered well and was discharged on post-operative day (POD) 14 with good recovery and follow up was uneventful. Spectrum of penetrating aortic injuries varies from stable patients to severely exsanguinated in vicious cycle of shock, acidosis, coagulopathy and arrhythmias causing high mortality and morbidity. Our case had contained retroperitoneal hematoma with stable vitals and good general condition and due to early diagnosis and timely institution of surgery the patient survived and recovered uneventfully. All abdominal stab injuries are to be taken as having vascular injuries. Surgery has to be taken up as an integral part of resuscitation with quickest and most effective diagnostics along with lifesaving procedures to have lesser morbidity and mortality.


Keywords


Stab injury, Abdominal aorta, Jejunum, Transection, Tamponade

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References


Asensio JA, Chahwan S, Hanpeter D, Demetriades D, Forno W, Gambara E, et al. Operative management and outcome of 302 abdominal vascular injuries. AAST-OIS correlates well with mortality. Southwestern Surgical Congress. Am J Surg. 2000;180:528-34.

Asensio JA, Forno W, Roldan G, Petrone P, Rojo E, Tillou A, et al. Abdominal vascular injuries: injuries to the aorta. Surg Clin North Am. 2001;81:1395-416.

Eder F, Meyer F, Huth C, Halloul Z, Lippert H. Penetrating abdomino-thoracic injuries: report of four impressive, spectacular and representative cases as well as their challenging surgical management. Pol Przegl Chir. 2011;83(3):117-22.

Mattox KL, Whisermard HH, Espada R, Beall AC. Management of acute combined injuries to the aorta and inferior vena cava. Am J Surg. 1975;130:720-4.

Coimbra R, Hoyt D, Winchell R, Simons R, Fortlage D, Garcia J. The ongoing challenge of retroperitoneal vascular injuries. Am J Surg. 1996;172(5):541-5.

Deree J, Shenvi E, Fortlage D, Stout P, Potenza B, Hoyt DB, et al. Patient factors and operating room resuscitation predict mortality in traumatic abdominal aortic injury: a 20-year analysis. J Vasc Surg. 2007;45:493-7.

DeBakey ME, Simeone FA. Battle injuries of the arteries in World War II; an analysis of 2,471 cases. Ann Surg. 1946;123:534-79.

Accola KD, Feliciano DV, Mattox KL, Bitondo CG, Burch JM, Beall AC, et al. Management of injuries to the suprarenal aorta. Am Surg. 1987;154:613-8.

Yang X, Xia L, Pan K. Delayed aortic rupture following perforating trauma. Ann Transl Med. 2014;2(10):102.

Dshanelidze I, Manuskript I, Petrograd. In: Thoracic Surgery. The Surgical Treatment of Thoracic Disease. Philadelphia, W. B. Saunders Co. 1926;489.

Beall AC, Roof WR, DeBakey ME. Successful surgical management of through-and-through stab wound of the aortic arch. Ann Surg. 1962;156(5):823-6.

Gnus J, Kasperczak M, Ferenc S. Abdominal stab wound with damage to the abdominal aorta and the left lobe of the liver - case report. Signa Vitae. 2018;14(1);86-7.

Shalhub S, Starnes BW, Tran NT, Hatsukami TS, Lundgren RS, Davis CW et al. Blunt abdominal aortic injury. J Vasc Surg. 2012;55(5):1277-85.

Azizzadeh A, Keyhani K, Miller CC 3rd, Coogan SM, Safi HJ, Estrera AL. Blunt traumatic aortic injury: initial experience with endovascular repair. J Vasc Surg. 2009;49:1403-8.

Starnes BW, Lundgren RS, Gunn M, Quade S, Hatsukami TS, Tran NT et al. A new classification scheme for treating blunt aortic injury. J Vasc Surg. 2012;55(1):47-54.

Myles RA, Yellin AE. Traumatic injuries of the abdominal aorta. Am J Surg. 1979;138:273-7.

Roberson G. Combined stab wounds of the aorta and vena cava of the abdomen. Arch Surg. 1967;95(1):12-5.

Lopez-Viego MA, Snyder WH, Valantine RJ, Clagett GP. Penetrating abdominal aortic trauma: A report of 129 cases. J Vase Surg. 1992;16:332-6.

Richards AJ Jr, Lamis PA Jr, Rogers JT Jr, Bradham GB. Laceration of abdominal aorta and study of intact abdominal wall as tamponade: report of survival and literature review. Ann Surg. 1966 Aug;164(2):321-4.

Kobayashi LM, Costantini TW, Hamel MG, Dierksheide JE, Coimbra R. Abdominal vascular trauma. Trauma Surg Acute Care Open. 2016;201(1):1-7.