Abstract
Introduction: Traditionally speaking, all patients with traumatic zone I hematomas should undergo operative exploration because of the high likelihood of injury to the aorta, the inferior vena cava, or one of the major mesenteric vessels. Case Description: We describe the case of a 26-year-old male patient who presented to our level 1 trauma center after sustaining a gunshot wound to his abdomen. Exploration revealed his main source of bleeding to be due to paraspinal arterial injury, specifically the transection of the artery of Adamkiewicz. Hemostasis was obtained via trans-vertebral packing. Discussion: Although traditional teaching dictates emergent operative exploration for patients with penetrating abdominal wounds and hemodynamic compromise, little guidance exists in the literature on the operative management of massive bleeding from paraspinal vessels. It is possible that in select cases, interventional radiologic measures might translate into better functional outcomes for patients with similar injuries.
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