Penetrating Abdominal Trauma in Pregnancy Complicated by Aortic, IVC, and Uterine Injuries: A Rare Case Report

Background: Trauma is the leading non-obstetric cause of maternal mortality and is associated with high fetal morbidity and mortality. Penetrating abdominal trauma during pregnancy is uncommon, but when complicated by major vascular and uterine injuries, it carries extremely poor outcomes. Case Presentation: A 34-year-old pregnant woman sustained multiple stab wounds to the abdomen and back. On arrival, she was conscious but hemodynamically unstable. E-FAST demonstrated intra-abdominal free fluid, and emergent laparotomy revealed a Zone 1inframesocolic hematoma. Both the infrarenal aorta and inferior vena cava (IVC) were injured. After obtaining supraceliac control, the vascular injuries were repaired with 4-0 Prolene sutures. Two full-thickness uterine perforations were identified, and hysterectomy was performed, resulting in delivery of a non-viable fetus. Postoperative CT showed additional thoracic injuries, including pneumothoraces and pulmonary contusions. The patient required left chest tube insertion but was extubated by postoperative day 2, transferred to the ward by day 4, and discharged home on day 8. At two-week follow-up, she remained clinically stable with a healed surgical wound. Conclusion: This case demonstrates the complexity of managing penetrating abdominal trauma in pregnancy, particularly when complicated by combined great vessel and uterine injuries. Maternal stabilization must be prioritized, as maternal survival remains the strongest determinant of fetal outcome. Despite poor fetal prognosis, timely diagnosis, aggressive resuscitation, prompt surgical repair, and multidisciplinary collaboration can result in successful maternal survival. Keywords: Pregnancy; Penetrating abdominal trauma; Aortic injury; Inferior vena cava injury; Uterine injury; Case report; Maternal survival; Fetal outcome 1. Demetriades D, Theodorou D, Murray J, Asensio JA, Cornwell EE 3rd, Velmahos G, et al. Mortality and prognostic factors in penetrating injuries of the aorta. J Trauma. 1996;40:761–3. 2. Fildes J, Reed L, Jones N, Martin M, Barrett J. Trauma: The leading cause of maternal death. J Trauma. 1992;32:643–5. 3. Peckham CH, King RW. A study of intercurrent conditions observed during pregnancy. Am J Obstet Gynecol. 1963;87:609–24. 4. von Oppell UO, Dunne TT, De Groot KM, Zilla P. Spinal cord protection in the absence of collateral circulation: meta-analysis of mortality and paraplegia. J Card Surg. 1994;9:685–91. 5. von Oppell UO, Dunne TT, De Groot MK, Zilla P. Traumatic aortic rupture: twenty-year meta-analysis of mortality risk of paraplegia. Ann Thorac Surg.1994; 58:585–93. 6. Morkovin V. Trauma in pregnancy. In: Farrel RG, editor. OB/GYN emergencies: the first 60 minutes, vol. 6. Rockville, USA: Aspen Publications; 1986. p. 71–86. 7. Lukaski HC, Siders WA, Nielsen EJ, Hall CB. Total body water in pregnancy: assessment by using bioelectrical impedance. Am J Clin Nutr. 1994;59:578–85. 8. Esposito TJ, Gens DR, Smith LG, Scorpio RJ, Buchman TG, Buechter KJ. Trauma during pregnancy: a review of 79 cases. Arch Surg. 1991;126:1073–8. 9. Parodi JC, Palmaz JC, Barone HD. Transfemoral intraluminal graft implantation for abdominal aortic aneurysms. Ann Vasc Surg. 1991;5:491–9. 10. Rousseau H, Midulla M, Marcheix B, et al. Indications for endovascular treatment: which treatment for acute traumatic aortic dissections? In: Amor M, Bergeron P, Inglese L, Ischinger T, Mathias K, Raithel D, editors. Thoracic combo from theory to practice: thoracic aortic dissections and their endovascular treatment. Marseille, France: Com; 2007. p. 192–202. 11. Tehrani HY, Peterson BG, Katariya K, et al. Endovascular repair of thoracic aortic tears. Ann Thorac Surg. 2006;82:873–7. 12. Agostinelli A, Saccani S, Borrello B, Nicolini F, Larini P, Gherli T. Immediate endovascular treatment of blunt aortic injury: our therapeutic strategy. J Thorac Cardiovasc Surg. 2006;131:1053–7.