Endovascular aortic repair for abdominal aortic injury complicated with bowel injury due to blunt abdominal trauma: A case report. (August 2021)

• Record Type: Journal Article
• Authors: Murata, Takaaki; Ogino, Hidemitsu; Isogai, Naoko; Kashiwagi, Hiroyuki; Shimoyama, Rai; Kawachi, Jun
• Is Part Of: International journal of surgery case reports. Volume 85(2021)
• Publication Date: 2021-08
• Subjects: BAAI blunt abdominal aortic injury -- CT computed tomography -- EVAR endovascular aortic repair -- ISS Injury Severity Score -- AIS abbreviated injury scale; Blunt abdominal aortic injury -- Blunt abdominal trauma -- Endovascular aortic repair -- Intestinal tract injury -- Case report; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2021.106216
• Languages: English
• ISSNs: 2210-2612

Abstract

Abstract: Introduction and importance: Blunt abdominal aortic injury (BAAI) resulting from blunt abdominal trauma is rare; therefore, there are no standard guidelines for its treatment. Herein, we report the successful treatment of BAAI via endovascular aortic repair (EVAR) performed immediately after emergency laparotomy to repair a bowel injury. Case presentation: A 78-year-old man was injured after being caught between a shovel car and the bumper of his own car for approximately 15 s. Upon arrival at the hospital, the patient was conscious and had stable vital signs, abdominal and low back pain, and numbness in the right lower limb. Computed tomography revealed contrast medium leakage into the mesentery, as well as aortic dissection and rupture. Hemostasis and intestinal resection were completed, and EVAR was performed immediately after abdominal closure. The patient was discharged from the hospital at 35 days after surgery. Clinical discussion: In this case, there existed a risk of artificial blood vessel infection if reconstruction was simultaneously performed with intestinal resection. Symptoms of lower limb ischemia that were observed prior to surgery resolved. After open surgery, bleeding was controlled, and the patient's vital signs were stable. EVAR was performed as treatment for aortic injury, thereby reducing the risk of direct implant infection and enabling minimally invasive treatment. Conclusion: EVAR may be useful for the treatment of BAAI in the presence of intestinal injuries, reduce the risk of implant infection, and allow for a one-time, minimally invasive treatment. Highlights: Blunt abdominal aortic injury (BAAI) resulting from blunt abdominal trauma is rare. Endovascular aortic repair may be useful in the treatment of BAAI. EVAR reduces the risk of implant infection.