Treatment priorities in combined blunt abdominal and aortic trauma.

Sixteen patients with blunt thoracic aortic transections also had intraabdominal injuries. Eleven patients had laparotomies first, and 5 patients had thoracotomies first. Records for the 16 patients were reviewed to identify successful treatment priorities. Active intraabdominal bleeding with present in 12 (75 percent) of the 16 patients. Bleeding was present in nine patients (82 percent) who underwent laparotomy first and in three patients (60 percent) who underwent thoracotomy first. Persistent or recurrent hypotension was associated with intraabdominal bleeding in eight patients. All patients had contained aortic hematomas and had successful repairs. Excluding early mortality related to associated injuries, the survival for patients who had laparotomy first was 63 percent and for patients who had thoracotomy first 60 percent. Laparotomy should be performed first in hypotensive patients with thoracic aortic transection and intraabdominal injury. The cause of hypotension is intraabdominal rather than aortic. In our study, delayed thoracotomy did not result in free rupture of the aortic hematoma.