Injuries of the abdominal aorta from blunt trauma.

Blunt injuries of the abdominal aorta are rarely reported in the literature. If left undiagnosed, these injuries may have catastrophic consequences. Four patients with blunt abdominal aortic lesions, identified in the authors' trauma registry, are presented in this report, along with a discussion of the pertinent literature to illustrate clinical management techniques. The mechanisms of injury include motor vehicular crashes (most frequent) with or without seatbelt use, abdominal blows, falls, and abdominal crush injuries. The spectrum of aortic lesions ranges from simple contusion or intramural hematoma to intimal disruption, false aneurysm, or frank rupture. Aortography should be performed in all stable patients with suspected aortic injury. All central-medial retroperitoneal hematomas discovered at laparotomy for blunt trauma should be explored after proximal and distal control of the aorta is obtained. Strict adherence to these principles, maintenance of standard vascular technique, and aggressive, expeditious resuscitative evaluation may improve survival.     

False aneurysm of the abdominal aorta after blunt trauma.

Injuries of the abdominal aorta due to blunt trauma are rare. So far, 33 cases have been reported in the English literature and false aneurysm formation after such injuries is even rarer. In this article, a case of false aneurysm of the abdominal aorta after blunt trauma in an acrobat which was successfully managed is reported, and the English literature for similar cases reviewed.     

True aneurysm of the abdominal aorta due to blunt trauma

This paper presents the case history of a 13-year-old boy who developed a true aneurysm of the abdominal aorta after a blunt abdominal trauma. A few months after the accident the aneurysmm was resected and replaced by a graft. Three previously published cases of abdominal aortic aneurysm after blunt trauma are briefly outlined. In each of these cases, however, a false aneurysm was involved. A traumatic aneurysm can develop after a penetrating or a blunt trauma, with complete or partial lesion of the aortic wall. Consequences of such a partial lesion are described. Operative treatment is required in the presence of an intimal flap or an aneurysm.     

Delayed jejunal perforation following blunt abdominal trauma

Jejunal perforation is a known complication of abdominal trauma. We report two cases of jejunal perforation presenting nearly 2 months following blunt injury to the abdomen and discuss possible mechanisms for delayed small bowel perforation.     

Isolated colonic injury following blunt abdominal trauma

A case of delayed diagnosis of colonic injury after blunt abdominal trauma leading to faecal peritonitis is presented. Diagnostic problems and possibilities as well as treatment of these injuries are reviewed. The key to diagnosis remains the serial clinical and ultrasound examinations.     

Bile duct injury following blunt abdominal trauma

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False aneurysm of the abdominal aorta due to blunt trauma.

Nonpenetrating trauma to the abdominal aorta is uncommon and the development of a traumatic abdominal aortic aneurysm is even more rare. The victims of blunt trauma to the abdomen should be examined for diminution or absence of femoral pulses, especially if numbness, diminished sensations, or motor weakness appear following trauma. If pulse abnormalities are present, aortography should be performed promptly to exclude aortic disruption or dissection. Immediate surgery should be performed once the diagnosis of aortic disruption is made. To our knowledge, this is the second reported case of successful surgical treatment of a false aneurysm of the abdominal aorta following nonpenetrating trauma.     

Intrahepatic bile duct rupture following blunt abdominal trauma

The natural history of intrahepatic bile duct rupture secondary to blunt trauma is not known. A unique case of bilateral hepatic lobar duct rupture is presented to demonstrate the clinical features and potential complications of this injury. Operative intervention is not always indicated and treatment should be dictated by the specific lesion.     

Chronic dissecting aneurysm of the thoracic aorta following minor blunt trauma

A 64-year-old man admitted for treatment of a thoracic aneurysm had experienced severe back pain 10 years earlier after falling heavily on his forearms. From the night following the fall, hoarseness and pleuritic chest wall pain continued for about 3 months. Preoperative imaging showed a chronic dissecting aneurysm near the aortic isthmus. The patient's history suggested that the fall 10 years before surgery was the most likely cause.