Management and imaging strategies in vertebral artery injuries due to penetrating neck trauma

Eleven patients with vertebral artery injury due to penetrating trauma were included in this prospective study. They were classified according to the clinical evidence of vascular injury into two groups: Group A included six patients showing hard signs suggestive of vascular injury and group B included five patients who were showing soft signs suspicious of vascular injury. Patients from group A who were vitally unstable [four patients] were taken immediately to the operation theater, while the other stable patients [two patients] did angiography to locate the site of injury and plan surgical approach. Proximal and distal ligation to the injured vertebral artery was done in three patients. Proximal ligation and packing with hemostatic agent were mandatory in two patients. A damage control was utilized in one patient. Patients from group B were subjected to MRA which was reliable to detect the site and type of injury; conservative treatment was adopted in all of them. The mortality rate was 9%. Massive blood transfusion, chylous fistula and pneumonia were the main postoperative complications. In spite of the ligation of the vertebral artery, none of the patients developed a neurological deficit. Patients who were managed conservatively and those who had proximal ligation and packing by hemostatic agents did not develop any late complications during the follow up period

role of non invasive imaging in the surgical management of the patients with mesenteric venous thrombosis

Twenty-one patients of surgically confirmed diagnosis of mesenteric venous thrombosis were included in this study. A detailed history was taken and thorough clinical examination was performed. The patients were divided into two groups: Group A included eight patients who showed an evidence of localized or generalized peritonitis and group B included 13 patients who showed nonspecific clinical findings. The duration of symptoms was significantly longer in patients from group A than group B. All patients were subjected to ultrasonographic abdominal examination with color flow Doppler scanning. It could suspect the diagnosis of mesenteric venous thrombosis in 62.5% and 76.9% of the patients in group A and B, respectively. Immediate surgical exploration was performed in all patients from group A without any further investigations. Contrast enhanced spiral CT was done in 11 patients from group B, while contrast enhanced MRI was done in the other 2 patients. A surgical exploration was done in all of them