TY - JOUR T1 - Aortoduodenal fistula after repair of a stab injury to the abdominal aorta JF - Trauma Surgery & Acute Care Open JO - Trauma Surg Acute Care Open DO - 10.1136/tsaco-2022-000882 VL - 7 IS - 1 SP - e000882 AU - David V Feliciano AU - Steven D Schwaitzberg AU - Joseph J DuBose Y1 - 2022/01/01 UR - http://tsaco.bmj.com/content/7/1/e000882.abstract N2 - An 18-year-old man presented to the trauma center with a stab wound to the left upper quadrant. His systolic blood pressure during transit was 30 mm Hg palpable.The patient was unresponsive. His systolic blood pressure was still 30 mm Hg palpable, heart rate was 140 beats/minute, and respiratory rate 30 breaths/minute with audible breath sounds bilaterally. Large bore intravenous catheters were inserted as an endotracheal tube was placed, and the patient was moved to the operating room. As a REBOA (resuscitative endovascular occlusion of the aorta) device was not available, a left anterolateral thoracotomy and cross-clamping of the descending thoracic aorta were performed. His heart was empty on palpation, and vigorous resuscitation with crystalloid solutions, packed red blood cells, and pressor medications slowly elevated the systolic blood pressure to 75 mm Hg.A midline laparotomy was performed, and a massive midline inframesocolic hematoma was noted as were multiple perforations of the jejunum and two perforations of the transverse colon. Dissection through the hematoma exposed a transection of the inferior mesenteric artery and vein, a 95% transection of the infrarenal abdominal aorta, and bleeding from a laceration of the mesentery of the small bowel. The ends of the inferior mesenteric artery and vein were ligated. The abdominal aorta was then reanastomosed using a continuous 3-0 polypropylene suture and buttressed with polytetrafluoroethylene (Teflon) pledgets, the jejunal and colonic perforations were repaired in two layers, and a large mesenteric vein was ligated. A prolonged period of infusion of packed red blood cells, blood products, crystalloid solutions, and epinephrine and dopamine was necessary before the cross-clamp on the descending thoracic aorta could be removed. The abdominal incision was closed using en bloc #2 polypropylene retention sutures. Postoperatively, the patient developed hyperbilirubinemia to 20 mg/dL total, an ileus, and then diarrhea with up to 17 bowel movements per … ER -