Management of Concomitant Traumatic Abdominal Vascular and Gastrointestinal Injuries: A Descriptive Study.

INTRODUCTION

Vascular injuries in contaminated fields secondary to intra-abdominal trauma present significant management challenges. When primary repair is not feasible, surgical dogma encourages avoidance of prosthetic grafts due to risk of infectious complications. Limited data exist characterizing the patterns of injury, reconstructive techniques utilized, and resultant outcomes.

METHODS

We conducted a retrospective review of adult patients who presented with traumatic intra-abdominal gastrointestinal and major vascular injury requiring emergent operative intervention from January 2012 to December 2021.

RESULTS

Fifty-one patients met inclusion criteria with 76 distinct vascular injuries, 28 arterial and 48 venous. Venous injuries were most often ligated (N = 39, 81%). Arterial injuries were initially managed with a variety of methods including shunting (N = 11, 39%), endovascular stenting (N = 5, 18%), biologic grafts (N = 5, 18%), prosthetic grafts (N = 3, 11%), primary repair (N = 3, 12%), and ligation (N = 1, 4%). There was no difference between prosthetic and biologic graft repairs in development of intraabdominal abscesses (60% versus 50%, P = 1.0), postoperative bacteremia (20% versus 25%, P = 1.0), or need for vascular reintervention (20 versus 25%, P = 0.8). Patients with colorectal injuries compared to those with noncolorectal gastrointestinal tract injuries had no difference in intraabdominal abscesses (N = 13 versus 11, P = 0.4), bacteremia (N = 10 versus 4, P = 0.5), or need for vascular reintervention (N = 3 versus 2, P = 0.4).

CONCLUSIONS

This is one of the largest case series to date describing traumatic intra-abdominal vascular injuries in contaminated fields. The use of prosthetic grafts in contaminated fields appears safe, but further prospective research is needed to determine the safety of this practice.