A case of acute abdominal aortic dissection caused by blunt trauma

Contemporary Strategies in the Management of Civilian Abdominal Vascular Trauma

The evaluation and management of patients with abdominal vascular trauma or injury requires immediate and effective decision-making in these unfavorable circumstances. The majority of these patients arrive at trauma centers in profound shock, secondary to massive blood loss, which is often unrelenting. Moreover, ischemia, compartment syndrome, thrombosis, and embolization may also be life threatening and require immediate intervention. To minimize the risk of these potentially lethal complications, early understanding of the disease process and emergent therapeutic intervention are necessary. In the literature, the management of acute traumatic vascular injuries is restricted to traditional open surgical techniques. However, in penetrating injuries surgeons often face a potentially contaminated field, which renders the placement of prosthetic grafts inappropriate. Currently, however, there are sparse data on the management of vascular trauma with endovascular techniques. The role of endovascular technique in penetrating abdominal vascular trauma, which is almost always associated with severe active bleeding, is limited. It is worth mentioning that hybrid operating rooms with angiographic radiology capabilities offer more opportunities for the management of this kind of injuries by either temporary control of the devastating bleeding using endovascular balloon tamponade or with embolization and stenting. On the other hand, blunt abdominal injuries are less dangerous and they could be treated at most times by endovascular means. Since surgeons continue to encounter abdominal vascular trauma, open and endovascular techniques will evolve constantly giving us encouraging messages for the near future.

Blunt Traumatic Occlusion of the Common Iliac Artery Repaired With Segmental Excision and Internal Iliac Artery Patch Angioplasty

Common iliac artery (CIA) occlusion as a result of blunt trauma is rare and seldom reported. This has been associated with pelvic fractures and other great vessel lesions. Management options include endovascular covered stent placement, open anatomic repair with autogenous conduit, or open extra-anatomic repair with prosthetic material. We report the case of a middle-aged male with a right CIA injury secondary to blunt trauma who underwent a successful repair using an internal iliac artery patch for injury to a 2 cm segment of CIA with peritoneal contamination. There is no definitively superior method to address CIA injuries in this setting reported in the literature. The use of the internal iliac artery as a patch can be regarded as an additional safe repair option when an autogenous repair is required for a large defect in the CIA as this can enable mobilization of the vessel for primary repair and offer a source for an autogenous patch.

Blunt traumatic infrarenal aortic intimal flap progressing to pseudoaneurysm over 3 months

Blunt traumatic infrarenal aortic injuries are unusual, and the formation of a delayed pseudoaneurysm of the aorta is even more rare. In this report, a young woman developed a small intimal flap of the infrarenal aorta after a motor vehicle accident which progressed into a 3 cm pseudoaneurysm after 3 months. Operative repair was successful and the patient recovered. This case illustrates the importance of repeat imaging of small blunt aortic injuries since progression can occur.

Abdominal vascular emergencies: US and CT assessment

Acute vascular emergencies can arise from direct traumatic injury to the vessel or be spontaneous (non-traumatic).The vascular injuries can also be divided into two categories: arteial injury and venous injury.Most of them are life-treatening emergencies, sice they may cause an important ipovolemic shock or severe ischemia in their end organ and require prompt diagnosis and treatment.In the different clinical scenarios, the correct diagnostic approach to vascular injuries isn't firmly established and advantages of one imaging technique over the other are not obvious.Ultrasound (US) is an easy accessible, safe and non-invasive diagnostic modality but Computed Tomography (CT) with multiphasic imaging study is an accurate modality to evaluate the abdominal vascular injuries therefore can be considered the primary imaging modality in vascular emergencies.The aim of this review article is to illustrate the different imaging options for the diagnosis of abdominal vascular emergencies, including traumatic and non traumatic vessel injuries, focusing of US and CT modalities.

Computed tomographic imaging findings of bowel ischemia

LEARNING OBJECTIVES

Learning objectives of this paper are to review and to summarize the pathogenesis of bowel ischemia and to describe its clinical, pathological, and radiological manifestations.

BACKGROUND

Bowel ischemia is a common disorder produced by several causes, and it shows various clinical presentations connected with an high mortality. With the increase in average life expectancy, bowel ischemia represents one of the most threatening abdominal conditions in elderly patients. In the last decade, computed tomography has tremendously altered the diagnostic approach to bowel ischemia also influencing the therapeutic approach in the current practice.

IMAGING FINDINGS

Computed tomographic imaging findings include bowel wall thickening, portal venous gas, intramural pneumatosis, engorgement of mesenteric veins, loss or increase of bowel wall enhancement, and infarction of other abdominal organs.

CONCLUSIONS

Bowel ischemia shows a broad spectrum of radiological manifestations, and regardless of the primary causes, it produces similar radiological features. Bowel ischemia may simulate cancer or inflammatory conditions; so it is a mandatory tight integration between radiological and clinical signs.

Multi-detector computed tomography findings of atypical blunt traumatic aortic injuries: a pictorial review

Traumatic injuries to the aorta are a significant source of morbidity and mortality in trauma patients, which highlights the importance of rapid diagnosis and treatment. Multi-detector row computed tomography has become the primary imaging modality for the imaging assessment of the polytrauma patient because it is fast, noninvasive, and the data sets can be used to create tailored multi-planar reformatted images that optimally display the location and morphology of aortic trauma and its relationship to adjacent structures. Although the classic location of blunt injury to the aorta occurs just distal to the left subclavian artery, aortic injuries may occur at any location along the aorta and in any patient population. Radiologists should be prepared to evaluate these types of injuries in nontraditional planes that are tailored to each examination and to present the data to clinicians using commercially available 3D software for purposes of surgical planning. Here, we review in pictorial form atypical aortic injuries with emphasis on multi-planar reformations.