Figures for:Injuries to the Great Vessels of the AbdomenACS Surgery. 2005; 2005 WebMD Inc.All rights reserved. Figure 1.Algorithm illustrates management of intra-abdominal hematoma found at operation after penetrating trauma.Figure 2.Algorithm illustrates management of intra-abdominal hematoma found at operation after blunt trauma.Figure 3.Left medial visceral rotation is performed by means of sharp and blunt dissection with elevation of the left colon, the left kidney, the spleen, the tail of the pancreas, and the gastric fundus.Figure 4.Shown is an autopsy view of the supraceliac aorta and the celiac axis, the proximal superior mesenteric artery, and the medially rotated left renal artery after removal of lymphatic and nerve tissue.Figure 5.An aortic compression device is used to control hemorrhage from the visceral portion of the abdominal aorta.Figure 6.A 22-year-old man with a gunshot wound to the right upper quadrant had injuries to the prepyloric area of the stomach and to the supraceliac abdominal aorta. The aortic injury was managed by means of segmental resection and replacement with a 16 mm polytetrafluoroethylene (PTFE) graft. The patient went home 46 days after injury.Figure 7.An 18-year-old man experienced a gunshot wound to the head of the pancreas and the proximal superior mesenteric artery. A Whipple procedure was performed, and a 6 mm PTFE graft was placed in the artery. The artery-graft suture line dehisced secondary to a pancreatic leak on day 30 after injury, and the patient died on day 42.Figure 8.(a) When complex grafting procedures to the superior mesenteric artery are necessary, it may be dangerous to place the proximal suture line near an associated pancreatic injury. (b) The proximal suture line should be on the lower aorta, away from the upper abdominal injuries, and should be covered with retroperitoneal tissue.Figure 9.Shown is a gunshot wound to the infrarenal abdominal aorta viewed through standard inframesocolic exposure. Patients head is at the bottom of the photograph.Figure 10.Shown is PTFE patch repair of an injury to the infrarenal inferior vena cava.Figure 11.A right perirenal hematoma was not opened at operation, because preoperative abdominal CT documented a reasonably intact kidney.Figure 12.Midline looping of respective renal vessels is performed before entry into any perirenal hematoma.Figure 13.A 24-year-old man experienced a gunshot wound to the left external iliac artery and vein. The arterial injury was repaired with segmental resection and insertion of an 8 mm PTFE graft; the venous injury was repaired with segmental resection and an end-to-end anastomosis.Figure 14.Failure to properly dissect out the structures in the porta hepatis after a penetrating wound led to the creation of an iatrogenic hepatic artery-portal vein fistula, which was corrected after the arrival of the attending surgeon.