Acute Abdominal Aortic Occlusion Due to Blunt Trauma

A case of acute abdominal aortic occlusion following blunt trauma is presented. A 39-year-old man was struck in the upper abdomen by the steering wheel of his car when he drove into a guard rail. The patient was admitted to a local hospital for observation, and approximately 5 hours after admission he developed leg pain. He was transferred to our hospital with paraplegia and signs of generalized peritonitis 15 hours after the injury. CT demonstrated pneumoperitoneum, damage to the pancreatic head, and abdominal aortic occlusion 4.5cm below the left renal artery. Laparotomy revealed severe combined pancreatoduodenal injury and complete abdominal aortic occlusion due to subintimal dissection and thrombosis. The injured aorta was excised and replaced with an EPTFE straight graft. Pancreaticoduodenectomy was carried out for the combined pancreatic duodenal injury followed by grafting. However, the patients died of MNMS 11 hours after revascularization. Earlier diagnosis and revascularization could possibly have saved this patient's life by avoiding MNMS from later reperfusion of the ischemic tissue.