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• W2021079437 abstract "A 69-year-old woman was brought to the accident and emergency department having been found unconscious at home. She was successfully given cardiopulmonary resuscitation by a neighbour (who had been an experienced surgical ward sister) and regained consciousness. On arrival she was pale, peripherally cold, with a pulse of 122 beats/min and blood pressure of 88/60. Abdominal examination revealed a tender epigastrium. Arterial blood gas analysis showed a pH of 7.381, pCO2 of 3.81 and pO2 of 14.07 on 15 l of oxygen/min. Her haemoglobin on the arterial blood gas was 8.9 g/dl. A retrospective history from the patient revealed that 5 days previously, she had been leading a horse out of stables when the animal had reared up causing her to be wrenched upwards by her arm, leading to a fall to the ground. There was no history of being kicked by the horse or falling onto a protruding object. This injured her right flank leading to extensive bruising from the axilla to the thigh on the right side of trunk. She attended the local accident and emergency department in Scotland and was discharged following examination and routine blood tests on the same day. Over the intervening days before collapsing, the patient was able to carry on her normal daily activities and drove approximately 300 miles back to her home to Essex. The patient was resuscitated with intravenous fluids and blood and improvement of the patient’s condition achieved. An emergency computed tomograph scan of the abdomen was organised at the suggestion of the duty vascular surgeon. However, the patient suddenly became haemodynamically unstable, started to lose consciousness and accordingly was transferred to theatre for a laparotomy. On opening the abdomen, there was a massive haemoperitoneum and a large well organised retroperitoneal haematoma extending from the left colon to over and above the right kidney. The liver and spleen were normal. The immediate suspicion was of a ruptured infra-renal aortic aneurysm. The aorta was thus clamped infra-renally and at the bifurcation of the common iliac vessels. After removal of the clot and exposure of the vessel, the aorta was found to be normal apart from a few calcified plaques of atheroma. At this point, the organised haematoma adjacent to the third part of the duodenum ruptured and a profuse haemorrhage occurred from close to the origin of the middle colic vessel. The duodenum and the ascending colon were further mobilised. On dissecting the haematoma, a 1 cm oblique, clean tear of the SMA proximal to the middle colic artery was seen. The vessel felt normal on palpation and this was primarily repaired with 3/0 Prolene. Pulsation of the mesenteric vessel distal to the repair was palpable. The bowel showed no evidence of ischaemic changes before, during or after the procedure. A further thorough examination of the abdomen including the lesser sac did not reveal any other pathology. Her cardiovascular status rapidly improved intraoperatively. The aortic clamps were carefully removed and no further bleeding was seen. Injury, Int. J. Care Injured (2004) 35, 1306—1307" @default.
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• W2021079437 date "2004-12-01" @default.
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• W2021079437 title "Delayed presentation of superior mesenteric artery rupture following blunt trauma" @default.
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• W2021079437 doi "https://doi.org/10.1016/j.injury.2003.12.006" @default.
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