Journal of Trauma and Injury

The Korean Society of Traumatology (대한외상학회)
권호 표지

Common Iliac Artery Injury due to Blunt Abdominal Trauma without a Pelvic Bone Fracture

복부 둔상 환자에서 골반 골절을 동반하지 않고 발생한 총장골동맥 손상 증례

  • Jung, Pil Young (Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Byun, Chun Sung (Department of Thoracic and Cardiovascular Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Oh, Joong Hwan (Department of Thoracic and Cardiovascular Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine) ;
  • Bae, Keum Seok (Department of Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine)
  • 정필영 (연세대학교 원주의과대학 원주세브란스기독병원 외과학교실) ;
  • 변천성 (연세대학교 원주의과대학 원주세브란스기독병원 흉부외과학교실) ;
  • 오중환 (연세대학교 원주의과대학 원주세브란스기독병원 흉부외과학교실) ;
  • 배금석 (연세대학교 원주의과대학 원주세브란스기독병원 외과학교실)
  • Received : 2014.11.09
  • Accepted : 2014.12.02
  • Published : 2014.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Blunt abdominal trauma may often cause multiple vascular injuries. However, common iliac artery injuries without associated bony injury are very rarely seen in trauma patients. In the present case, a 77-year-old male patient who had no medical history was admitted via the emergency room with blunt abdominal trauma caused by a forklift. At admission, the patient was in shock and had abdominal distension. On abdomino-pelvic computed tomography (CT), the patient was seen to have hemoperitoneum, right common iliac artery thrombosis and left common iliac artery rupture. During surgery, an additional injury to inferior vena cava was confirmed, and a primary repair of the inferior vena cava was successfully performed. However, the bleeding from the left common iliac artery could not be controlled, even with multiple sutures, so the left common iliac artery was ligated. Through an inguinal skin incision, the right common iliac artery thrombosis was removed with a Forgaty catheter and a femoral-to-femoral bypass graft was successfully performed. After the post-operative 13th day, on a follow-up CT angiography, the femoral-to-femoral bypass graft was seen to have good patency, but a right common iliac artery dissection was diagnosed. Thus, a right common iliac artery stent was inserted. Finally, the patient was discharged without complications.

Keywords

References

  1. Muck PE, Nunez TC, Hruska L, Kasper GC, Chang CK, Welling RE. Blunt injury to the external iliac artery: a case report. Am Surg 2002; 68: 11-4.
  2. Buscaglia LC, Matolo N, Macbeth A. Common iliac artery injury from blunt trauma: case reports. J Trauma 1989; 29: 697-9. https://doi.org/10.1097/00005373-198905000-00029
  3. Carrillo EH, Wohltmann CD, Spain DA, Schmieg RE Jr, Miller FB, Richardson JD. Common and external iliac artery injuries associated with pelvic fractures. J Orthop Trauma 1999;13:351-5. https://doi.org/10.1097/00005131-199906000-00005
  4. Asensio JA, Chahwan S, Hanpeter D, Demetriades D, Forno W, Gambaro E, et al. Operative management and outcome of 302 abdominal vascular injuries. Am J Surg 2000; 180: 528- 33. https://doi.org/10.1016/S0002-9610(00)00519-5
  5. Nitecki S, Karmeli R, Ben-Arieh Y, Schramek A, Torem S. Seatbelt injury to the common iliac artery: report of two cases and review of the literature. J Trauma 1992; 33: 935-8. https://doi.org/10.1097/00005373-199212000-00029
  6. Herskowitz MM, Sclafani SJ. Acute traumatic dissection of the common iliac arteries with spontaneous healing: case report. Cardiovasc Intervent Radiol 1990; 13: 364-6. https://doi.org/10.1007/BF02578676
  7. Frick EJ Jr, Pasquale MD, Cipolle MD. Small-bowel and mesentery injuries in blunt trauma. J Trauma 1999; 46: 920-6. https://doi.org/10.1097/00005373-199905000-00024
  8. Eastridge BJ, Burgess AR. Pedestrian pelvic fractures: 5-year experience of a major urban trauma center. J Trauma 1997; 42: 695-700. https://doi.org/10.1097/00005373-199704000-00019
  9. Burch JM, Richardson RJ, Martin RR, Mattox KL. Penetrating iliac vascular injuries: recent experience with 233 consecutive patients. J Trauma 1990; 30: 1450-9. https://doi.org/10.1097/00005373-199012000-00003
  10. Roth SM, Wheeler JR, Gregory RT, Gayle RG, Parent FN, Demasi R, et al. Blunt injury of the abdominal aorta: a review. J Trauma 1997; 42: 748-55. https://doi.org/10.1097/00005373-199704000-00032
  11. Thomford NR, Curtiss PH, Marable SA. Injuries of the iliac and femoral arteries associated with blunt skeletal trauma. J Trauma 1969; 9: 126-34. https://doi.org/10.1097/00005373-196902000-00004
  12. Tsai FC, Wang CC, Fang JF, Lin PJ, Kao CL, Hseih HC, et al. Isolated common iliac artery occlusion secondary to atherosclerotic plaque rupture from blunt abdominal trauma: case report and review of the literature. J Trauma 1997; 42: 133-6. https://doi.org/10.1097/00005373-199701000-00024
  13. Tuech JJ, Villapadierna F, Singland JD, Papon X, Pessaux P, Vergos M. Blunt injury to the common iliac artery. Eur J Vasc Endovasc Surg 2000; 20: 47-50. https://doi.org/10.1053/ejvs.2000.1118
  14. Gupta N, Auer A, Troop B. Seat belt-related injury to the common iliac artery: case report and review of the literature. J Trauma 1998; 45: 419-21. https://doi.org/10.1097/00005373-199808000-00044
  15. Vernhet H, Marty-Ane CH, Lesnik A, Chircop R, Serres- Cousine O, Picard E, et al. Dissection of the abdominal aorta in blunt trauma: management by percutaneous stent placement. Cardiovasc Intervent Radiol 1997; 20: 473-6. https://doi.org/10.1007/s002709900197