Blunt disruption of the abdominal aorta: Report of a case and review of the literature

Abstract

A 71-year-old woman had an abdominal aortic disruption as a belted passenger in a motor vehicle accident. The diagnosis was unexpected, and the patient died during surgery. There have been 54 patients operated with this diagnosis since 1953; our patient was the fifty-fifth. This is an unusual injury, because the aorta is well protected in this position. Thoracic aortic injuries are much more common (20 times) than abdominal injuries. The causes are motor vehicle accidents, blows to the abdomen, explosions, and falls. Obstructing lesions such as thrombosis and intimal dissection are the more common presentation. False aneurysms occur occasionally. Free rupture has a very high and immediate mortality rate, and few patients arrive at the hospital alive. Diagnosis can be clinical, based on distal ischemia and neurologic abnormalities, or made with Doppler scanning, ultrasonography, computed tomography, or arteriography. Two thirds present acutely and one third subsequently months or even years after the original injury. Treatment consists of flap suture, thrombectomy, bypass grafting in more extensive injury, or extra-anatomic bypass in the face of severe contamination. Recently, endoluminal stenting has successfully been used, avoiding an abdominal operation completely.

Seat Belt Syndrome and Aortoiliac Lesion: Case Report and Review of the Literature

“…The advanced age and aortoiliac atherosclerosis of this patient corroborates the idea of an increased risk of intimal rupture in arteries with decreased elasticity [13,28].…”

“…Synthetic grafts are ideal for aortoiliac and aortobifemoral repairs, because of their easy manipulation and faster placement. When there is intestinal disruption and grossly peritoneal contamination, the use of prosthetic grafts is generally contraindicated [13,23,28]. In these cases, we should use autogenous grafts or artery ligation with extra-anatomical revascularization procedures [35].…”

Inframesocolic Abdominal Aortic Injury and Lumbar Vertebral Body Fracture Secondary to Hyperextension with Blunt Trauma

“…It is so uncommon that a recent review article in the New England Journal of Medicine on ''Blunt aortic injury'' only reviewed the mechanisms, pathophysiology, diagnosis, and treatment of injuries to the thoracic aorta [1]. The rarity of this diagnosis is due in part to the protected position of the abdominal aorta and the high mortality of the injury when it occurs; therefore, patients who sustain this injury seldom reach the hospital still alive [2]. Raghavendran et al [3] noted only seven reports of traumatic abdominal aortic pseudoaneurysm in the literature.…”

An Abdominal Aortic Rupture Due to Seatbelt Blunt Injury: Report of a Case

“…Two major mechanisms have been proposed to explain blunt abdominal aortic injury; direct and indirect force. [1][2][3][4] Direct force can damage the aorta by inducing violent compression against the spine, and indirect force operates by compression of the adjacent organs building up extremely high pressure in the aorta. In addition, atherosclerotic change in the aorta can also predispose to a disruption.…”

“…In addition, an aortic dissection with thrombosis is its most common presentation, and few ruptures have been reported. [1][2][3][4][5] We herein present a successful surgical repair of an abdominal aortic rupture due to seatbelt blunt injury.…”