Traumatic dissection of the external iliac artery

Case contributed by Dr Andrew Dixon

Presentation

Pedestrian hit and dragged by vehicle.

Patient Data

Age: 60
Gender: Female

Trauma Series

Modality: X-ray

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.  

Abdomen and Pelvis CT

Modality: CT

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 haematoma.  

One month later

Modality: X-ray

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 ischaemia necessitating amputation. Complex pelvic fractures and abdominal wall injuries. 

The ischaemic leg was obvious clinically, however this case does emphasise the importance of making sure you trace all major arteries on trauma scans to ensure you don't miss a potentially treatable vascular injury. 

PlayAdd to Share

Case Information

rID: 31668
Case created: 20th Oct 2014
Last edited: 26th Oct 2016
System: Vascular
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.