Abdominal vascular trauma: type of vascular injuries Hospital de Kennedy 2002-2007 Trauma vascular abdominal: tipo de lesiones vasculares hospital de Kennedy 2002-2007

Abstract

Introduction: abdominal vascular injuries are highly difficult and challenging. They feature the lethal vicious cycle of shock, acidosis, hypothermia, hypocoagulability and heart arrhythmias. This study's objective is to describe the frequency and epidemiologic characteristics of cases handled at Hospital Occidente de Kennedy during the last 5 years. Materials and Methods: review of 150 clinical records of patients seen between January 2002 and December 2007 with main diagnosis of abdominal vascular trauma. Those in which study variables were not adequately recor­ ded were excluded. Results: men were mostly affected (85.3%) and average age was 28.9 years. The most common identification method was acute abdomen (112 cases, 74.6%). The most frequent trauma mechanism was penetra­ ting trauma by a gunshot wound (80 cases, 53.3%). The most frequent injuries were classified as grade III (86) and associated intra-abdominal organ injured was small intestine (28, 18.6%). Ali patients underwent a laparotomy and thoracotomy was performed in 22 (15%). Primary suture was the most used repair method (104, 69.3%). Sepsis was the main complication (14, 9.3%). Mortality rate was 42.6% (60 cases). Injuries most frequently associated with mortality involved the infrarenal and retrohepatic aorta, vena cava and portal, mesentheric and iliac vessels. Death was due to intra-abdominal sepsis in 6 patients. Clinical recovery: 86 patients survived; out of 20 cases with an open abdomen, ten (6.6 %) progressed positively and incisional hernia repair with mesh graft was performed subsequently; 46 recovered in the immediate postoperative period and experienced early dismissal (type 1-11). Complications in the remaining patients were managed with amputation in 4 cases, and bowel fistula and antibiotics for infected wounds. Conclusions: an adequate approach and control of vascular injuries allows management with simple procedures such as a lateral suture. The three major vessel injuries associated to high mortality rate involve the aorta, vena cava and portal vein. Ischemia, injury mechanisms, associated impairments, chronic vascular disease and clinical findings must be considered to determine prognosis.