Laparotomy management of diaphragmatic and hollow viscera rupture combined with thoracic endovascular aortic repair after a traffic accident: A case report

INTRODUCTION: Road traffic incidents are the most common cause of multiple organ trauma in low- and middle-income countries. Multiple blunt intra-abdominal organs that rupture in conjunction with a ruptured aorta are terrible and rare. CASE PRESENTATION: A 65-year-old man sustained critical injuries during a traffic collision between a motorcycle and truck. The Injury Severity Score was 42 points,. After open abdominal exploration, we repaired the left diaphragmatic rupture with a 13-cm-long tear of IV grade (American Association for the Surgery of Trauma), resected partial small bowel, simple suture of the transverse colon, and Hartmann procedure in the descending colon. Thoracic endovascular aortic repair (TEVAR) was performed 22 h after laparotomy. Reconstruction of the head depicting a cheekbone fracture and inferior to the left orbital bone was performed on the 14th day. The patients survived and were discharged from the hospital, at 22 days without morbidity or mortality. DISCUSSION: Diaphragmatic rupture provides a signal to relate head, thoracic, and abdominal blunt trauma. If the patient sustains more serious life-threatening injuries that require emergency laparotomy or craniotomy, and aortic repair may be delayed. Laparotomy is the best initial surgical method in this case. TEVAR is a feasible and gold standard procedure for the treatment of patients with the necessary indications. CONCLUSION: It is essential to evaluate the level of organ damage to properly coordinate the specialists. The timing of the operation and therapeutic alternatives should be decided for each patient.