Lesiones vasculares abdominales: El desafío del cirujano de trauma

Abstract

Introducción: Las lesiones vasculares abdominales presentan los mayores índices de mortalidad y morbilidad de entre todas las lesiones que puede sufrir un enfermo traumático.Método: Revisión de la clínica, diagnóstico, vías de abordaje y tratamiento de los pacientes con lesiones vasculares intraabdominales, basada en la experiencia en el manejo de 302 enfermos.Resultados: Las heridas penetrantes abdominales constituyen entre el 90%-95% de las lesiones que afectana los vasos abadominales. La lesión abdominal multiorgánica es frecuente. Los hallazgos clínicos compatibles con hemoperitoneo o peritonitis y la ausencia de pulsos femorales son tributarios de laparotomía. En los pacientes que presentan parocardiorespiratorio, se debe realizar toracotomía de urgencia para masaje cardiaco abierto y pinzamiento aórtico.La mortalidad global es del 54%, la exsanguinación representa el 85% de la misma. El síndrome compartimental en el abdomen y en las extremidades, así como el círculo vicioso de la acidosis, la hipotermia y la coagulopatía son las principales complicaciones.Conclusiones: Las lesiones vasculares abdominales presentan una alta mortalidad y morbilidad. El conocimiento anatómico del retroperitoneo y de las vías de abordaje de los vasos así como una exploración clínica adecuada ayudaran a disminuir las complicaciones y la mortalidad de estos pacientes.

The cost of gunshot abdominal vascular injuries: Its impact on patient, family, and hospital

“…Heuer et al 18 reported 10,530 (1.5% of emergency department admissions) cases of abdominal trauma patients with severe vascular injuries in 218 hospitals, over a period of 16 years in Germany; in this case, the difference could be due to the number of hospitals included and the time dedicated to the study. In our country, a comparative reference of a trauma center is Mexico City's Mexican Red Cross Trauma Center itself: in a retrospective study between 2015 and 2017 19 , 42,909 admissions to the emergency department were reported, 1.4% with gunshot wound diagnosis, out of 3 estimated that abdominal vascular injuries are associated with a mean of two to four additional injuries; in our study, we observed that 100% of patients had associated abdominal injuries, with an average of 4.1; an amount similar to the upper limit reported in the referred article. Asensio et al 3 also reported that multiple vascular injury is common; however, we found that 83.3% of patients had injury to a single vessel.…”

“…In our country, a comparative reference of a trauma center is Mexico City's Mexican Red Cross Trauma Center itself: in a retrospective study between 2015 and 2017 19 , 42,909 admissions to the emergency department were reported, 1.4% with gunshot wound diagnosis, out of 3 estimated that abdominal vascular injuries are associated with a mean of two to four additional injuries; in our study, we observed that 100% of patients had associated abdominal injuries, with an average of 4.1; an amount similar to the upper limit reported in the referred article. Asensio et al 3 also reported that multiple vascular injury is common; however, we found that 83.3% of patients had injury to a single vessel. Evidently, the relevance of additional injuries lies not only in the overall increase in the severity index of the wound but also in the complexity and duration of the required treatment, as well as in the risk for developing complications 6,8,20,21 .…”

“…Penetrating abdominal wounds cause 90-95% of abdominal vascular lesions (which are found in 22-25% of patients undergoing laparotomy for gunshot abdominal injuries) and are estimated to be associated with a mean of two to four additional injuries; in addition, it is common for multiple vessel involvement to be observed. In general terms, lethality of arterial injuries is 35-85% and that of venous injuries is 50-90% [1][2][3][4] .…”