Blunt aortic injury with concomitant intra-abdominal solid organ injury: treatment priorities revisited

J Trauma. 2002 Sep;53(3):442-5; discussion 445. doi: 10.1097/00005373-200209000-00008.


Background: Patients with blunt aortic injury (BAI) often have concomitant liver or spleen (L/S) injuries. With increasing use of cardiopulmonary bypass with heparinization in repair of BAI, many advocate operative management of the L/S injury before aortic repair to eliminate risk of hemorrhage. We evaluated the safety of nonoperative management (NOM) of blunt L/S injuries in patients undergoing acute BAI repair with bypass.

Methods: All patients admitted over a 6-year period with BAI were identified from the registry of our Level I trauma center. Patients with isolated L/S injuries without BAI admitted over the same period served as controls. Groups were compared with regard to demographics, injury characteristics, hospital course, and mortality.

Results: Eighty-four patients were diagnosed with BAI from 1994 to 2000; 28 (33%) also had blunt abdominal trauma. Three patients with severe brain injury did not undergo BAI repair, and five required laparotomy before BAI repair for other intra-abdominal injuries (two for hemodynamic instability with splenic injury, and three for concomitant bowel injury). Therefore, 20 of 28 (71.4%) BAI patients with grade I or II L/S injury (Aorta L/S group) underwent planned NOM. All BAIs were repaired using partial bypass with full heparinization. These 20 patients are compared with 894 patients with grade I or II L/S injuries with no BAI (L/S group) over the same time period. There was no difference in the nonoperative failure rate of the Aorta L/S group versus the L/S group (0% vs. 1.7%). Both groups had similar complication rates. The Aorta L/S group was also compared with 56 BAIs without solid organ injury (Aorta group). Although the Aorta L/S group was more severely injured than the Aorta group (Injury Severity Score of 35.3 vs. 26.8, < 0.0001), transfusion rates (5.7 U of packed red blood cells vs. 8.0 U of packed red blood cells, p = NS), hospital days (17.9 vs. 19.1, p = NS) and mortality (10% vs. 9%, p = NS) were similar.

Conclusion: NOM of patients with grade I or II L/S injury who undergo systemic anticoagulation with heparin for repair of BAI is safe and associated with transfusion rates similar to BAI alone. Patients with low-grade liver or spleen injuries do not require laparotomy before BAI repair using partial bypass.

MeSH terms

  • Abdominal Injuries / complications
  • Abdominal Injuries / mortality
  • Abdominal Injuries / pathology
  • Abdominal Injuries / therapy*
  • Adult
  • Aorta, Thoracic / diagnostic imaging
  • Aorta, Thoracic / injuries*
  • Critical Care* / methods
  • Female
  • Humans
  • Injury Severity Score
  • Liver / injuries
  • Male
  • Medical Records
  • Multiple Trauma / complications
  • Multiple Trauma / mortality
  • Multiple Trauma / pathology
  • Multiple Trauma / therapy*
  • Outcome Assessment, Health Care*
  • Postoperative Complications
  • Radiography
  • Retrospective Studies
  • Spleen / injuries
  • Tennessee / epidemiology
  • Trauma Centers / statistics & numerical data*
  • Wounds, Nonpenetrating / complications
  • Wounds, Nonpenetrating / mortality
  • Wounds, Nonpenetrating / pathology
  • Wounds, Nonpenetrating / therapy*