Common iliac artery occlusion with small intestinal transection caused by blunt abdominal trauma: A case report and review of the literature

A case of multiple organ injury resuscitated by collaboration of damage control surgery and interventional radiology in hybrid emergency room

Background

Hybrid emergency room systems, namely hybrid ER (HER), enable us to perform computed tomography (CT), surgery, and interventional radiology (IVR) without patient transfer. HER significantly shortened the time to CT after arrival and allowed us to achieve early intervention, resulting in reduced mortality from exsanguination in patients with severe blunt trauma.

Case Presentation

We encountered a patient diagnosed with left common iliac artery occlusion and dissection caused by blunt traumatic compressive abdominal injury with transection of the small intestine, kidney, and adrenal and pelvic ring fractures. Although the patient experienced cardiopulmonary arrest (CPA) immediately after CT, we performed damage control surgery (DCS) and IVR after temporary aortic occlusion in the HER and resuscitated the patient.

Conclusion

The present case, in which rapid diagnosis and intervention were performed and the patient was successfully resuscitated, supports the efficacy of the HER system for managing severe blunt trauma.

Acute external iliac artery thrombosis following pelvic fractures: Two case reports

RATIONALE

Pelvic fractures associated with acute external iliac artery thrombosis is less common, it is easily ignored in clinical practice, and it can result in limb amputation and hemipelvectomy due to prolonged limb ischemia. We present 2 patients with acute external iliac artery thrombosis following pelvic fractures.

PATIENT CONCERNS

Case 1 is a 49-year-old male with occlusion of the right external iliac artery and pelvic fractures. Case 2 is a 52-year-old male with left external iliac artery occlusion and bilateral internal iliac artery rupture following pelvic fractures.

DIAGNOSES

Case 1 was diagnosed with computed tomography angiography. Case 2 was diagnosed with ultrasound examination and computed tomography angiography.

INTERVENTIONS

Case 1 was performed an open incision to remove thrombus of the right external iliac artery, the right iliac-femoral artery artificial bypass was adopted to restore the blood flow. Case 2 underwent segmental resection of the damaged artery and artificial vascular implantation of left external iliac artery, and angiographic embolization of bilateral internal iliac artery. However, a left hip disarticulation was performed due to osteofascial compartment syndrome at last.

OUTCOMES

Case 1 was cured and discharged smoothly. Case 2 survived but left with a disability after disarticulation.

LESSONS

Acute external iliac artery thrombosis after pelvic fractures is rare and limb-threatening, life-threatening. It is very important to detect and treat this potential complication timely when a patient with a pelvic fracture.

Blunt vascular trauma in a patient with peripheral arterial disease: a case report and review of the literature

Blunt vascular trauma is rare and challenging in management. Trauma victims who are elderly and have medical comorbidities are still uncommon, but their proportion is expected to increase, as life expectancy has been rising worldwide. A case of blunt vascular trauma to the lower extremity in a 70-year-old patient is reported. During the procedure, a contusion of the superficial femoral artery with thrombosis was identified. Besides, the artery was found to be affected by atherosclerosis. Thrombectomy with resection of the artery and end-to-end anastomosis was performed. Good early clinical outcome was achieved. Nonsystematic review of the available literature is also presented.