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Traditionally speaking, all patients with traumatic zone I hematomas should undergooperative exploration because of the high likelihood of injury to the aorta, the inferior vena cava, or one ofthe major mesenteric vessels.Case Description: We describe the case of a 26-year-old male patient who presented to our level 1 traumacenter after sustaining a gunshot wound to his abdomen. Exploration revealed his main source of bleedingto be due to paraspinal arterial injury, specifically the transection of the artery of Adamkiewicz. Hemostasiswas obtained via trans-vertebral packing.Discussion: Although traditional teaching dictates emergent operative exploration for patients withpenetrating abdominal wounds and hemodynamic compromise, little guidance exists in the literature on theoperative management of massive bleeding from paraspinal vessels. It is possible that in select cases,interventional radiologic measures might translate into better functional outcomes for patients with similarinjuries.

Gunshot Wound to Abdomen Causing Life-Threatening Zone I Retroperitoneal Hematoma from Artery of Adamkiewicz