The Medico-legal Implications for the Vascular Surgeon of the Delayed Effects of Blunt Abdominal Trauma

D Moneley, A Dueck, FM Ameli
Department of Vascular Surgery, St Michael’s Hospital, Toronto, Ontario

 We present three cases of delayed vascular injury following blunt abdominal trauma all of which have undergone medico-legal investigation.

The first case involves a 55 year old man who presented to the Emergency department after suffering a cardiac arrest. Of note in his past medical history he had been involved in a motor vehicle accident fifteen months previously and suffered a mild blunt abdominal injury and soft tissue injuries to his chest. A post mortem revealed a 12cm AAA with free rupture into the peritoneal cavity.

The second case involves a 17 year old boy who again was involved in a motor vehicle accident and sustained a severe blunt abdominal injury resulting in a compression fracture of L3,4 requiring spinal fusion and a localized dissection of his infra-renal aorta which extended from the level of his IMA to the Aortic bifurcation. He has undergone subsequent CT/US assessment of his aorta which indicated his Aorta may have increased in size by 3-4mm.

The third case involves a 30 year old man who was involved in a fight and sustained multiple blows to the epigastric and umbilical area of his abdomen. Subsequent to this he had been suffering from intermittent bouts of upper abdominal pain. Seven months later during an acute presentation he underwent  a laparotomy and resection of  infarcted small bowel which lay in the distribution of the superior mesenteric artery.

We feel that these cases have important potential medico legal implications for Vascular Surgeons with regard to the follow up and treatment of patients who undergo blunt abdominal trauma.