ABSTRACT

Although abdominal vascular injuries due to missile bullets are less common compared to other injuries, they are of great importance because of the high mortality rate. There are many factors affecting the mortality rate such as; transportation time, type of injury, visceral organ damages, amount of blood loss and surgical experience of the medical and surgical team. The aim of this study is to assess the mortality rate of abdominal vascular injury caused by the bullets of rifles when visceral organs injury is associated with vascular injury.

Between 1993-2008, registries in surgery department of the hospitals affiliated to Başkent University were scanned and 27 abdominal vascular injuries of a total of 212 abdominal wound cases were detected. The mean age was 24±12 years (22 men and 5 women). Ages ranged from 12 to 58 years. The cause of injury was a mine explosion and firearm in one patient, and firearms in the others. All cases had vascular injuries. 16 cases had major venous injuries, 6 had major arterial injuries and the remaining 5 cases have major arterial and venous injuries.

Fifty-four abdominal organ injuries were determined. Twenty-seven of these 54 patients had abdominal vascular injuries. Only one patient’s systolic blood pressure was higher than 50 mmHg in the preoperative period. The remaining patients had lower systolic blood pressures. In addition, the blood pressure of ten patients could not be determined during admission to the emergency department. Major venous injuries had the worst preoperative hemodynamics. Twenty-three of 54 patients had liver injury (42.59%), stomach injury in 14 patients (25.92%), right kidney injury in 7 patients (12.96), left kidney injury in 5 patients (9.25%) and multiple organ injuries in 2 patients (3.7%). Eight patients underwent vascular ligation, primary repair was done in 12 patients and graft interposition was done in 7 patients. However, 5 cases died before surgical intervention. Out of 5 deaths, one patient died because of sepsis (postoperative 2nd day), one patient died from VCI laceration, sepsis occurred in one, 1 died from renal venous trauma, 1 from vena porta injury and one from cerebral hemorrhage associated with abdominal vascular injury. The management of inferior caval vein injuries, which are responsible for 60% of all deaths, were the most challenging.

Vascular traumas within the abdominal area are fatal clinical conditions and complications. Abdominal aortic injuries have a higher fatality rate than venous injuries. Outcomes in abdominal vascular injuries due to missile wounds still depend on transportation time and coincident inferior caval vein and abdominal organ injuries. (JAREM 2014; 1: 25-7)

Keywords: Abdominal, vascular injuries, missile wounds