|
Abdominal Vasculature
Access to the abdominal aorta in this setting is best achieved
by complete medial visceral rotation of the left side of the abdomen.
The left colon, spleen and kidney are mobilized and the visceral
rotated medially to expose the entire length of the abdominal
aorta (the Mattox manoeuver).
Left medial visceral rotation
(Mattox)
If in the hands of an experienced vascular surgeon the aorta
should be rapidly repaired with direct suture or interposition
PTFE graft. However in extreme cases or where this expertise does
not exist, the use of intravascular shunts may be considered.
A large portion of tube thoracostomy tube is used for the abdominal
aorta. Iliac injuries are more suitable for shunting and carotid
shunts, thoracostomy tubing or large-bore IV tubing may be utilized.
These may also be useful for superior mesenteric artery injuries.
intra-arterial shunt in left common iliac artery
courtesy: Asher Hirshberg MD
|
Inferior vena cava injuries may be managed by direct suture
if amenable, or packing if retrohepatic. Temporary control
is best achieved with direct pressure above and below the
injury using sponge-sticks. Otherwise venous injuries should
be ligated in the damage control setting.
Opening a pelvic retroperitoneal haematoma in the presence
of a pelvic fracture is almost universally fatal - even
if the internal iliacs are successfully ligated. In this
case the retroperitoneum should not be opened but the pelvis
packed with large abdominal packs. The pelvis should be
stabilized prior to this (a sheet tied tightly around greater
trochanters and pubis is adequate) to prevent the packing
procedure opening the pelvic fracture and increasing the
haemorrhage.
|
 |
|
