Abdominal large blood vessel injury

Brief introduction of abdominal large vessel injury Abdominal great vascular injury (abdominalgreatvascular injury) mainly refers to abdominal aorta and inferior vena cava damage, serious injuries. More than 50% of patients with abdominal aortic injury die before being sent to the hospital. The cause of death is mainly hemorrhage or visceral injury. basic knowledge The proportion of illness: the incidence rate of abdominal trauma patients is about 5-10% Susceptible people: no special people Mode of infection: non-infectious Complications: hemorrhagic shock peritonitis hematuria

Causes of abdominal large blood vessel injury

Trauma factors (95%):

More than 90% of abdominal aortic injuries are caused by penetrating trauma, the most common being gunshot wounds (mostly), knife stab wounds, etc., a small part caused by blunt trauma; and most of the damage and part of the inferior vena cava Abdominal aorta injury is caused by blunt trauma to the abdomen, such as traffic accidents, falls and injuries in high places.

Iatrogenic factors (5%):

In particular, the sagittal trauma of the liver in one and two halves is most likely to be associated with damage to the inferior vena cava. A portion of the inferior vena cava injury is caused by a sharp penetrating injury or iatrogenic injury.

Pathogenesis

The blunt injury of the abdominal aorta, often the displacement of the lumbar vertebrae, or the blunt injury in front of it and the posterior aorta in the posterior lumbar vertebrae, the damage of the vessel wall, aortic occlusion, embolism, trauma Aneurysm formation and hemorrhage around the abdominal aorta, abdominal aortic penetrating injury due to massive hemorrhage, hematoma caused by abdominal aorta injury above the renal artery is generally limited, and abdominal aortic injury below the renal artery is not limited, blood Influx into the abdominal cavity to form a huge hematoma, often reaching the anterior abdominal wall, inferior vena cava damage to wear through injury, knife stab wounds and lacerations more common, severe bleeding, blood hematoma and thrombosis.

Abdominal macrovascular injury prevention

1. Develop good habits, stop smoking and limit alcohol. Smoking, the World Health Organization predicts that if people no longer smoke, after five years, the world's cancer will be reduced by 1/3; secondly, no alcohol. Smoke and alcohol are extremely acidic and acidic substances. People who smoke and drink for a long time can easily lead to acidic body.

2. Don't eat too much salty and spicy food, don't eat food that is overheated, too cold, expired and deteriorated; those who are frail or have certain genetic diseases should eat some anti-cancer foods and high alkali content as appropriate. Alkaline foods maintain a good mental state.

Abdominal macrovascular injury complications Complications hemorrhagic shock peritonitis hematuria

(1) Shock: For severe hemorrhagic shock, the condition is dangerous.

(2) abdominal distension, abdominal pain and hemorrhage: sudden abdominal trauma stimulation, peritonitis and abdominal distension can cause abdominal pain, but its nature and degree are different, open injury can be massive bleeding from the wound, arterial blood color is bright red, can be pulsating Sexual bleeding, it is worth noting that in some cases, peritoneal hemorrhage caused by damage to the abdominal large blood vessels can be recessive, with little blood in the abdominal cavity.

(3) Abdominal large blood vessel damage is often accompanied by small intestine, liver, pancreas, colon, kidney and other injuries and spinal fracture displacement, in addition to the above symptoms, acute peritonitis, hematuria, anuria, hematemesis, blood in the stool and Nervous system dysfunction, etc.

Abdominal large blood vessel injury symptoms Common symptoms Abdominal pain Peritonitis Blood in the stool Open injury Liver dullness circle shrinks or disappears Peritoneal stimulation sign Abdominal blood bloating

Symptom

(1) Shock: For severe hemorrhagic shock, the condition is dangerous and is a common cause of early death.

(2) abdominal distension, abdominal pain and hemorrhage: sudden abdominal trauma stimulation, peritonitis and abdominal distension can cause abdominal pain, but its nature and degree are different, open injury can be massive bleeding from the wound, arterial blood color is bright red, can be pulsating Sexual bleeding, it is worth noting that in some cases, peritoneal hemorrhage caused by damage to the abdominal large blood vessels can be recessive, and there is little blood in the abdominal cavity. A typical example is a knife stab wound in the lower back, and the blade is from the lower two ribs. Partial piercing.

(3) Abdominal large blood vessel damage is often accompanied by small intestine, liver, pancreas, colon, kidney and other injuries and spinal fracture displacement, in addition to the above symptoms, acute peritonitis, hematuria, anuria, hematemesis, blood in the stool and Nervous system dysfunction, etc.

2. Due to a large number of blood loss, the general condition is poor, the blood pressure drops sharply or can not be measured, the pulse speed is too fast to touch, or the breathing is shallow, the consciousness is unclear, the face is pale, the limbs are cold, etc., the abdomen is bulging, sharpness Injury from the wound bleeding, such as combined with digestive damage, digestive tract content or digestive juice flow to the abdominal cavity, there may be tenderness, rebound tenderness, muscle tension and other peritoneal irritation signs, moving voiced positive, auscultation of weak or disappeared bowel sounds.

Examination of abdominal large vessel injury

1. Emergency blood tests, blood type, urine routine, blood urea gelatinase and other tests.

2. Detection of blood peritoneal fluid by abdominal perforation should be performed by smear test and amylase content to eliminate the possibility of digestive tract injury.

In the emergency state, the requirements are prompt and comprehensive.

3. Abdominal puncture and abdominal puncture is especially suitable for closed abdominal injury. It is useful for judging whether there is damage to the abdominal viscera and what kind of organ damage. If there is damage to the large blood vessels in the abdominal cavity, it is easy to withdraw non-clotting, and the blood is extracted. The liquid is usually smeared and the amylase content is measured to determine whether there is damage to other organs. In some cases, the abdominal wear can not penetrate the liquid, but the possibility of damage to the blood vessels and organs in the abdominal cavity cannot be ruled out.

4. X-ray inspection

(1) X-ray examination of the chest and abdomen: visible under the armpits, pleural effusion and the size, shape and position of some organs, when there is a hematoma in the retroperitoneum, the shadow of the psoas muscle can disappear.

(2) angiography: when the patient's conditions permit, the abdominal aorta and inferior vena cava angiography should be performed to determine the location, extent and extent of vascular injury, especially those with vascular injury caused by blunt abdominal trauma. At the same time, it can be checked for the damage of its branch vessels.

(3) CT and MRI: It is helpful for the diagnosis of abdominal large vessel injury.

(4) Others: When patients with suspected renal vascular injury (especially blunt trauma to the abdomen), renal parenchymal injury and hematuria, intravenous pyelography and CT renal scan should be performed, if there is renal damage or kidney Development, renal angiography should be done.

5. Ultrasound examination B-ultrasound can detect the presence of effusion in the thoracic and abdominal cavity, the shape and size of some organs, the evolution of hematoma in the organs. In addition, ultrasound Doppler can detect the traumatic abdominal aorta Breakage and blockage.

Diagnosis and diagnosis of abdominal large vessel injury

The patient has a history of abdominal or low back trauma, clinical signs of severe shock, abdominal hemorrhage, peritoneal irritation and other signs, imaging examinations such as angiography, CT and other indications of abdominal large vessel injury, generally can make a diagnosis, but because of injury In critical condition, most patients have no time to do further imaging studies, so the majority of the final diagnosis was achieved during surgical exploration.

The patient has a history of abdominal or low back trauma, clinical signs of severe shock, abdominal hemorrhage, peritoneal irritation and other signs, imaging examinations such as angiography, CT and other indications of abdominal large vessel injury, generally can make a diagnosis, but because of injury The situation is critical, and most patients have no time to do further imaging studies.

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