A patient sustained traumatic injury to major abdominal vessels. It has been planned to explore the suprarenal aorta, the coeliac axes, the superior mesenteric artery and the lift renal artery. What maneuver for exposure is recommended? (AIPG 2010)
|A||Cranial visual rotation|
|B||Caudal visual rotation|
|C||Lift medial visual rotation|
|D||Right medial visual rotation|
In a traumatic injury to abdominal vessels, enter the peritoneal cavity through a midline incision.
If there is Midline supramesocolic hemorrhage or hematoma (superior to the transverse mesocolon), one should follow following steps.
a. This problem is usually from an injury to the suprarenal aorta, celiac axis, proximal superior mesenteric artery, or proximal renal artery.
b. Use aortic compression to obtain proximal aortic control at the hiatus.
c. Once aortic control is achieved, gain direct access to the vessels through retroperitoneal mobilization and medial rotation of all left-sided abdominal viscera (Mattox maneuver) or an extensive Kocher maneuver on the right side.
d. An injured celiac axis may be safely ligated in critical situations.
e. Access to the superior mesenteric artery and vein may require transection of the pancreas. Primary repair of this major vessel is usually the first choice; however, ligation, particularly of the venous structures, may be a better option. Significant venous congestion can compromise viability of the bowel.
f. For best visualization of the internal iliac artery, elevate the common and external iliac arteries on vascular tapes.
g. Repair injuries to the common or external iliac arteries.
h. Treat injuries to the iliac veins with lateral venography or ligation.
i. Once initial control of the hemorrhage is completed and gross contamination is controlled, terminate the procedure and transfer the patient to the recovery room for further resuscitation. Measurement of abdominal compartment pressure may be needed.