Fotios Kyramargios (Pireus / GR), Nikolaos Giannakopoulos (Pireus / GR), Styliani Vederaki (Pireus / GR), Georgios Bekakos (Pireus / GR), Ariadni Tsiaka (Pireus / GR), Foteini Stefou (Pireus / GR), Nikolaos Vlachakos (Pireus / GR)
Abstract text (incl. references and figure legends)
CASE HISTORY
A 54 year old male came in A&E after a MVA
CLINICAL FINDINGS
The patient was hemodynamically unstable tachypnoic and tachycardic bruises were inspected on left iliac fossa and epigatrium .The patient was on clopidogrel and salospir treatment after two coronary artery angioplasties three months ago.
INVESTIGATIONS/RESULTS
Patient"s complete blood count was normal although the focused assessment with sonography in trauma revealed free fluid in abdominal cavity and in order to establish the source of bleeding abdominal CT with intravenous infusion was ordered and it revealed active exsanguination in left iliac fossa
DIAGNOSIS
Blunt abdominal trauma
THERAPY AND PROGRESSIONS
Exploratory laparotomy via a midline incision was performed measurable blood collection found on left paracolic gutter an arterial branch of a sigmoid artery was bled actively. The branch was transfixed and ligated in addition minor laceration found on cecum which primarely sutured.Two penrose drained the right and left paracolic gutter.Tintraoperative the patient eceived two units of FFP ,one unit of RBC and 2gramms of tranexamic acid.The patient followed an uncomplicated stable postoperative period and he discharged on 11th postoperative day.
COMMENTS
Such minor arterial branches found to exsaguinate in closed abdominal trauma could be managed by arterial embolization although in unstable patients who are under antiplatelet therapy this endovascular is very challenging ,in addition the collection of blood should be evacuated because of potential postoperative septic complications.
REFERENCES
1)Ahmet K, Tongue Y. Blunt abdominal trauma: evaluation of diagnostic options and surgical outcomes. Turkish J Trauma Emerg Surg 2008;14:205-10
2)Asensio JA, Chahwan S, Hanpeter D, et al. Operative management and outcome of 302 abdominal vascular injuries. Am J Surg. 2000;180:528–33. discussion 533–4.
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