Elsevier

Injury

Volume 32, Issue 3, April 2001, Pages 201-207
Injury

Blunt abdominal aortic trauma in association with thoracolumbar spine fractures

https://doi.org/10.1016/S0020-1383(00)00203-5Get rights and content

Abstract

All patients with blunt abdominal aortic disruption (BAAD) in the trauma registries at the three Regional Trauma Centres were retrospectively reviewed over the last decade. From the 11 465 trauma admissions ISS>16, 194 sustained aortic injuries. Eight cases of BAAD were identified, six with concurrent thoracolumbar spine (TLS) fractures (mean ISS 42). Patients with BAAD and TLS were subject to a detailed analysis. Clinically, three injury types were seen, hemodynamically unstable (uncontained full thickness laceration), stable symptomatic (intimal dissection with occlusion), and stable asymptomatic (contained full thickness laceration or intimal dissection without occlusion). All spinal column fractures involved a distractive mechanism, one with both distractive and translational fracture components. We propose that a distractive force, applied to the aorta lying anterior to the anterior longitudinal ligament, results in an aortic injury spectrum ranging from an intimal tear to a full thickness laceration, as a related injury. Computed tomography (CT) was an important imaging modality in the stable asymptomatic patients. All intimal dissections without occlusion were managed non-operatively. With distractive TLS fractures, BAAD needs to be considered.

Introduction

Despite the relative frequency of traumatic disruption of the thoracic aorta, blunt abdominal aortic disruption (BAAD) remains an uncommon injury. The actual number of well documented cases was recently reported to number only 76 [1], and is certainly less than 100, [2], [3], [4], [5], [6], [7], [8]. A comprehensive review of this injury was conducted at three major Canadian trauma centres. During this study, an apparent association of BAAD with distracting thoracolumbar spine (TLS) fractures was seen. While autopsy studies and case series [9], [10], have alluded to this association, there is little documentation of the mechanism of injury, the types of aortic and spinal injuries, management, and outcomes. Only 15 such clinical cases have been reported to date. Five cases are reviewed in detail. An injury association between BAAD and distracting TLS fractures is suggested which may have implications for further study and management of blunt trauma victims.

Section snippets

Material and methods

The Regional Trauma Unit at Sunnybrook and Women's College Health Sciences Centre (SWCHSC) is a Regional Trauma Centre serving Metropolitan Toronto and southern Ontario. The London Health Sciences Centre (LHSC) is the Regional Trauma Centre serving South-western Ontario. The Vancouver Hospital and Health Sciences Centre (VHHSC) is the regional and provincial Trauma Centre in the province of British Columbia. All participate in a trauma registry and collect comprehensive data on all trauma

Results

At SWCHSC, between 1986 and 1997, 6504 injured patients were admitted with an ISS greater than 16. There were 76 aortic injuries; seven of which occurred to the abdominal segment from blunt trauma, including one injury to a pre-existing abdominal aortic aneurysm (Table 2). At LHSC between 1991 and 1997, 1790 patients were admitted with an ISS greater than 16. Of these, 36 patients had an aortic injury, but only two occurred in the abdominal aorta from blunt trauma. One of the two blunt injuries

Discussion

Thoracolumbar spine (TLS) fractures are common in severe blunt trauma, occurring in up to 9% of cases [13]. Associated injuries are well recorded [14], [15], [16], [17], [18], [19], [20], with visceral or mesenteric damage seen in up to 60–70% of chance type fractures of the spine [21], [22], [23]. Autopsy studies have suggested an association between chance fractures and BAAD [9], [10], [24]. However, there is poor clinical documentation of this injury resulting in an inadequate understanding

Conclusion

Blunt abdominal aortic trauma remains rare but TLS fractures especially due to distractive forces may be a marker. Uncontained full thickness lacerations present with hemodynamic instability. Intimal dissections with occlusion cause vascular symptoms and will require further investigation or intervention. The diagnosis of contained full thickness lacerations and intimal dissections without occlusion is difficult but important. A CT scan is a useful imaging modality in these injuries. Intimal

Acknowledgements

Sharon Kasic, Manager, British Columbia Trauma Registry, Vancouver, British Columbia; T Charyk Stewart, London Health Sciences Centre Trauma Registry; Phillip Sharkey, Sunnybrook Regional Trauma Centre Data Registry, Toronto, Ontario.

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    This work was presented at the Trauma Association of Canada (TAC) meeting Montreal, Quebec, Canada, 24 September 1999

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