Presentation
Pedestrian hit and dragged by vehicle.
Patient Data
Trauma radiograph with pelvic binder applied. Widening of both sacro-iliac joints. Fracture of the left inferior pubic ramus and suspicion of left superior pubic ramus near the acetabulum.
In addition to the pelvic fractures and sacro-iliac joint diastases seen on the x-ray, the major traumatic finding on the CT is complete traumatic dissection of the left external iliac artery with non-enhancement of the artery distal to this point including the femoral artery. Collapsed IVC and shocked bowel appearance. There is a substantial traumatic defect in the lower anterior abdominal skin and subcutaneous fat and injury to the left lower and lateral portions of the anterior abdominal wall with partial herniation of the descending colon. Large left flank subcutaneous hematoma.
Left leg amputation, left SI joint plate and screw fusion and right femoral intramedullary rod now evident.
Case Discussion
Traumatic dissection of the left external iliac artery with complete vessel occlusion leading to acute leg ischemia necessitating amputation. Complex pelvic fractures and abdominal wall injuries.
The ischemic leg was obvious clinically, however this case does emphasize the importance of making sure you trace all major arteries on trauma scans to ensure you don't miss a potentially treatable vascular injury.
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