Intra-abdominal vascular trauma-a need for prompt operation.

Prompt operative intervention to obtain vascular control is the most important factor in the treatment of intra-abdominal vascular injuries. In 81 patients with major abdominal vascular injuries, bullet wounds were the cause of injury in 51, stab wounds in 12, blunt trauma in ten, shot gun in seven, and one was an iatrogenic injury from insertion of a dialysis catheter. Twenty-nine of 81 patients died (35.8%). Twenty patients (70%) died of massive blood loss at operation or in the early postoperative period. Hypovolemic shock was the predominant distinguishing feature in the mortality group. The mortality rate increased with the number of associated nonvascular injuries, ranging from 20% in patients without associated injuries to 100% in patients with five or more associated injuries. The mortality rate was also increased with the number of vessels injured, ranging form 20% with one or two injured vessels to 100% with four or more. Late deaths occurred in nine patients and were most commonly related to the complications of hypovolemic shock. In hospital settings where patients can be resuscitated in the operating room, prolonged stay in the Emergency Department for diagnostic and laboratory evaluation only delays the operative vascular control of exsanguinating hemorrhage.