Management of gunshot injury to the
abdominal aorta and inferior vena cava: a case
report of a combat patient wounded in the
Russo-Ukrainian war

Management of gunshot injury to the
abdominal aorta and inferior vena cava: a case
report of a combat patient wounded in the
Russo-Ukrainian war

Russo-Ukrainian war is associated with severe traumas, including injuries to the major vessels.

Abstract
Background Russo-Ukrainian war is associated with severe traumas, including injuries to the major vessels.
Penetrating aortic injury remains one of the most difficult injuries; the mortality rate is 90–100% in case of gunshot
wounds, associated with frequent lethal outcomes due to uncontrolled bleeding. Of the three main abdominal
veins, the inferior vena cava (IVC) is the most frequently damaged, which is required quick and appropriate surgical
decisions to be made. Little is known about the management of gunshot injuries to such major vessels as the aorta
and IVC. It is also worth mentioning about the importance to share our practical experience from the ongoing war
for better understanding and future considerations by war surgeons of the vascular trauma management. The aim
of the study was to demonstrate the specific features of the diagnosis and management of a gunshot shrapnel blind
penetrating wound to the abdomen with injury to the aortic bifurcation level and the infrarenal section of the inferior
vena cava.
Case presentation A 44-year-old male soldier of the Armed Forces of Ukraine received a gunshot injury to the
abdomen from a mortars’ explosive shelling. The patient was evacuated to the Forward Surgical Team (Role 1) and
received primary surgical treatment within one hour after the injury according to the “golden hour” principle. Then,

evacuated was performed to the Role 3 hospital in Kharkiv. At the Role 3 hospital, the patient underwent second-
look surgery as well as damage control surgery. At revision, no active bleeding was observed, and the surgical pads

(packed previously by the Forward Surgical Team) were removed. Further revision showed a metal projectile within
the aortic wall at the level of aortic bifurcation and wall defects were also detected for inferior vena cava. This metal
projectile was removed by using the multifunctional surgical magnetic tool followed by suturing of the aortic wall
defect as well as defects of the inferior vena cava.
Conclusions Application of Damage Control Surgery is a useful approach in the management of severe vascular
injury as well as useful to stop abdominal contamination by intestinal contents. The application of a surgical magnetic

Igor Lurin1,2, Eduard Khoroshun3,4, Vitalii Makarov3,4, Volodymyr Negoduiko3,4, Serhii Shypilov3,4, Yurii Bunin3
,

Maksym Gorobeiko1,5,6 and Andrii Dinets1,5,7*

https://doi.org/10.1186/s12245-024-00690-6

2024

Peri Irawan

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