In order to expose the coeliac axis, left renal aery, superior mesenteric aery and abdominal aoa in a case of trauma, which of the following is performed :Left medial visceral rotation
Ans. is 'a' i.e. Left medial visceral rotation The major abdominal vessels are retroperitoneal structures that lie posterior to the contents of peritoneal sac & close to the midline. The vessels which are notoriously difficult to expose are : retrohepatic vena cava, suprarenal aoa; the coeliac axis; the proximal superior mesentric aery; the junction of the superior mesentric, splenic and poal veins and the bifurcation of the vena cava. Rapid exposure of these vessels can be accomplished during abdominal trauma by following maneuvers : - The principle behind visceral rotation is to rotate the viscera of one side towards the midline after freeing their lateral peritoneal attachments so as to expose the vessels of that side A left medial visceral rotation (Mattox maneuver) provides excellent exposure of the aoa, coeliac axis, superior mesentric aery, left renal aery and iliac aeries. A right medial visceral rotation (Catell maneuver) readily exposes the vena cava (with a combined Kocher maneuver), right renal vessels and iliac veins. The infrarenal aoa may be approached a transperitoneal incision at the base of the mesocolon. The junction of the superior mesentric, splenic and poal veins can be readily exposed in trauma surgery by dividing the neck of the pancreas. The bifurcation of the vena cava is obscured by the right common iliac aery. This vessel is to be divided to expose extensive vena caval injuries of this area.
Left medial visceral rotation
Right medial visceral rotation
Cranial visceral rotation
Caudal visceral rotation