Shunt Management of an Aortic Gunshot Injury With Staged Reconstruction

A 17-year-old boy arrived alert but in stage IV hemorrhagic shock with an abdominal gunshot injury. Because of the injury and hemodynamic instability, he was taken directly to the operating room and found to have an anterior and posterior injury to the infrarenal aorta and a concomitant small bowel injury. Massive transfusion protocol was initiated, and a shunt was placed in the aorta. The injured bowel was resected and left in discontinuity with an open abdomen as he was resuscitated in the intensive care unit for his hypotension and hypothermia. We returned to surgery the next day and repaired his aortic injury with a prosthetic tube graft. The trauma team took him back for a third operation to restore bowel continuity and abdominal closure. Postoperatively, he recovered uneventfully without any signs of infection. A 1-month postoperative computed tomography scan showed a patent aortic repair without pseudoaneurysm. Aortic shunting is rarely used in trauma surgery, but we think it was valuable in maintaining lower extremity perfusion, allowing resuscitation and staged aortic repair under stable conditions