Published online Aug 6, 2019. doi: 10.12998/wjcc.v7.i15.2120
Peer-review started: February 27, 2019
First decision: May 31, 2019
Revised: June 22, 2019
Accepted: July 2, 2019
Article in press: July 3, 2019
Published online: August 6, 2019
Most major abdominal vascular injuries are caused by penetrating injuries. A common iliac artery occlusion caused by blunt force trauma is rare, and very few cases have been reported. Because of this low incidence, atypical symptoms, and frequent association with other severe injuries, the proper diagnosis tends to be missed or delayed. The gold standard for diagnosis is angiography, and treatment remains a challenge.
We report here the unusual case of a common iliac artery occlusion caused by blunt abdominal compressive trauma, with transection of the small intestine. At presentation, the patient (a 56-year-old man) complained of pain and numbness in the left lower extremity and severe pain in the whole abdomen. Physical examination showed total abdominal tenderness with evidence of peritoneal irritation. The left lower limb was pulseless and cold. Abdominal computed tomography examination revealed digestive tract perforation, and abdominal computed tomography angiography showed left common iliac artery occlusion. The patient was treated successfully by anastomosis of the intestine, percutaneous transluminal angioplasty, and stenting. The patient was followed for more than 11 mo after the operation and showed a good recovery.
Patients with abdominal trauma should be suspected of having major vascular injury. Individualized treatment strategies are needed for this condition.
Core tip: Most major abdominal vascular injuries are caused by penetrating injuries. As a subset of arterial blunt trauma, the percentage of iliac arterial injury is small. Common iliac artery occlusion in blunt trauma is especially uncommon. We report such a rare case here. Furthermore, we review the reported cases in the English literature and provide a discussion on the mechanism of injury, clinical presentation and signs, diagnosis, surgical modalities, and outcome.