Haroon Javaid Majid, Muhammad Farooq Afzal, Khalid Iqbal, Mehmood Ayyaz, Muhammad Arshad Cheema.
Critical factors in determining mortality from penetrating abdominal vascular trauma: the Mayo Hospital experience.
Pak J Surg Jan ;20(1):1-7.

Mayo Hospital Lahore is a big and busy trauma center in Pakistan that receives a substantial number of patients with penetrating abdominal trauma. Vascular injuries in these patients are not uncommon. They are difficult to repair and are usually associated with a high mortality. The purpose of this study was to review treatment principles, complications and factors affecting the outcome variables in our setup in these cases, the main outcome variable being survival. Complete medical records of 411 patients with penetrating abdominal injuries, operated in our emergency over a four years period (January 1996 – December 1999), were reviewed. Amongst these 57(13.86%) had significant abdominal vascular injuries. The commonest afflicting agents were firearms (81%). The overall mortality was 31.5%. The highest mortality was associated with retro-hepatic vena caval injuries (66.6%). Very high mortality rates were seen in patients who were admitted with un-recordable blood pressure (72.2%) and in patients who had combined arterial and venous injuries i.e. more than one abdominal vascular injury (42.8%). Mortality seems to be directly related to the site of the vascular injury (high for supra-renal / retro-hepatic vena caval injuries), the presence of shock on admission, free bleeding and the lack of retro-peritoneal tamponade at the time of surgery, and the presence of additional vascular injuries. The major cause of death in our patients was profound shock due to uncontrolled bleeding. Early diagnosis, prompt intervention and effective management could result in improved salvage rates.

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