Beckenfraktur mit schockierender arterieller retroperitonealer Blutung und gleichzeitigem Extremitäten-Ischämiesyndrom: Diskussion des Managements anhand eines Fallbeispieles [Pelvic fracture with shock-inducing retroperitoneal bleeding and concomitant lower extremity ischemia syndrome: discussion of management exemplified by a case report].

Details

Serval ID
serval:BIB_83E6BA1DC787
Type
Article: article from journal or magazin.
Publication sub-type
Case report (case report): feedback on an observation with a short commentary.
Collection
Publications
Title
Beckenfraktur mit schockierender arterieller retroperitonealer Blutung und gleichzeitigem Extremitäten-Ischämiesyndrom: Diskussion des Managements anhand eines Fallbeispieles [Pelvic fracture with shock-inducing retroperitoneal bleeding and concomitant lower extremity ischemia syndrome: discussion of management exemplified by a case report].
Journal
Swiss Surgery = Schweizer Chirurgie = Chirurgie Suisse = Chirurgia Svizzera
Author(s)
Furrer M., Gautier E., Triller J., Gilg M., Würsten H.U.
ISSN
1023-9332 (Print)
ISSN-L
1023-9332
Publication state
Published
Issued date
1996
Volume
2
Number
6
Pages
238-243
Language
german
Notes
Publication types: Case Reports ; English Abstract ; Journal ArticlePublication Status: ppublish
Abstract
BACKGROUND: Initial treatment of severe pelvic fracture consists of appropriate resuscitation and early pelvic reposition and stabilization. Concomitant retroperitoneal arterial bleeding in a hemodynamically unstable patient in combination with lower extremity ischemia make early management decisions very difficult and the mortality rate of this entity of injuries is extremely high.
CASE REPORT: We report on a successful treatment of a 36 year old skier, referred in hemorrhagic shock, who had sustained a severely displaced both column fracture of the right acetabulum, an unstable pelvic ring injury on the left and a retroperitoneal bladder rupture. He developed complete ischemia of the right lower extremity. Angiography revealed an obliteration without extravasation of the external iliac artery and allowed treatment of a right superior gluteal artery disruption by embolization. The right lower extremity ischemia was revascularized with a subcutaneous femoro-femoral bypass graft. Delayed internal fixation of the right acetabulum and exploration of the iliac vasculature was done through an ilio-inguinal approach. Simultaneously, the cross-over bypass could be removed. After 18 months, the patient recovered without any ischemic symptoms, but continues with a mixed sciatic nerve lesion.
DISCUSSION AND CONCLUSIONS: The combination of severe retroperitoneal arterial bleeding and total ischemia of the lower extremity requires immediate surgical therapy. Direct exploration of the retroperitoneum, however, can be fatal and should be avoided if the iliac vessels are angiographically intact or if a hemorrhage is controllable by an embolization procedure. Extraanatomic temporary revascularization of the lower extremity should be envisaged when a lower leg ischemia due to obliteration or compression of major intrapelvic vessels cannot be directly and immediately treated.
Keywords
Abdominal Injuries/radiography, Abdominal Injuries/surgery, Adult, Angiography, Digital Subtraction, Arteries/injuries, Blood Vessel Prosthesis, Embolization, Therapeutic, Fractures, Bone/complications, Fractures, Bone/radiography, Humans, Ischemia/etiology, Ischemia/surgery, Leg/blood supply, Male, Pelvic Bones/injuries, Rupture
Pubmed
Create date
26/11/2012 20:25
Last modification date
03/03/2018 18:53
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