[Supracoeliac aortic clamping. Technique and indication in traumatic abdominal pathology]

Supracoeliac occlusion of the aorta was performed in two patients with visceral and vascular lesions due to blunt abdominal trauma. In both cases, aortic occlusion was required due to peroperative hypovolaemic shock. The first case was a 30-year-old man hospitalized for blunt thoracic and abdominal trauma. Haemodynamic parameters were unstable at admission with initial blood pressure at 85/45 mmHg. Physical examination indicated a haemoperitonium which was confirmed echographically. At laparotomy, among other injuries, the right supra-hepatologic vein and two posterior veins draining the segment VII were severed. Despite suture and haemostatic procedures, hypovolaemic shock occurred with systolic pressure at 40 mmHg. In the second case, haemoperitonium was also confirmed echographically in a 28-year-old man hospitalized for blunt frontal abdominal trauma. Blood pressure was 70/45 mmHg at admission and emergency laparotomy revealed major avulsion of the left lobe of the liver and lesions to the sub-renal vena cava and the left renal vein in addition to major injury to the pancreas and the stomach. While the supra-coeliac aorta was being prepared, persistent bleeding led to shock with a systolic pressure of 45 mmHg. In both cases, the supracoeliac artery was clamped, for 30 and 35 minutes respectively, making it possible to re-establish satisfactory haemodynamic conditions and allowing favourable outcome. These observations demonstrate that per-operative occlusion of the supracoeliac aorta performed as a salvage manoeuvre in cases of hypovolaemic shock can be an effective means of re-establishing a precarious haemodynamic situation. The technique is simple and rapid and few complications have been reported.