Successful endovascular therapy in an elderly patient with severe hemorrhage caused by traumatic injury

AbstractAn 85-year-old female suffered pelvic fracture, multiple rib fractures, right hemopneumothorax, and blunt abdominal aortic injury in a traffic accident. After transfer to our hospital, transcatheter arterial embolization (TAE) was performed immediately for hemorrhage from the bilateral internal iliac arteries. Enhanced computed tomography (CT) after TAE showed an increase of hematoma and extravasation at the bifurcation of the abdominal aorta. Therefore, emergency abdominal endovascular aortic repair was performed on the same day. On the 3rd day after transfer, metabolic acidosis worsened suddenly, and enhanced CT revealed intestinal necrosis. Emergency surgery for the intestinal necrosis was performed. The patient was transferred to the previous hospital on the 31st day after transfer. Endovascular treatment is useful for elderly patients with severe trauma. However, the preservation and/or reconstruction of the blood flow to important organs should be monitored.

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A case of non-occlusive mesenteric ischaemia caused by pelvic fracture due to fall trauma

Surgical Case Reports ◽

10.1186/s40792-020-01046-x ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

Yuichiro Furutani ◽

Kaname Ishiguro ◽

Masato Tokuraku ◽

Hitoshi Moritomo

Keyword(s):

Sigmoid Colon ◽

Pelvic Fracture ◽

Traumatic Injury ◽

Arterial Embolization ◽

Ascending Colon ◽

Mesenteric Ischaemia ◽

Intestinal Necrosis ◽

Fall Injury ◽

Internal Iliac ◽

Traumatic Bleeding

Abstract Background Non-occlusive mesenteric ischaemia (NOMI) is a condition in which intestinal ischaemia arises due to spasms of peripheral blood vessels; however, there is no obstruction of the main arteries. Risk factors include hypertension, diabetes, and increasing age, but the traumatic injury triggering NOMI onset is rarely reported. We report a case of NOMI caused by a pelvic fracture due to a fall injury. Case presentation A 77-year-old man was transported to the hospital due to a fall injury. CT revealed a pelvic fracture and a haematoma in the pelvic extraperitoneal space. The next day, the patient developed shock, and CT revealed an increase in haematoma size. Both internal iliac arteries were embolized by transcatheter arterial embolization (TAE). The next day’s CT revealed intestinal necrosis of the ascending colon, and emergency surgery was planned. During surgery, necrosis was identified in the serosa of the ascending, transverse, and sigmoid colon. We performed subtotal excision from the ascending colon to the sigmoid colon. On postoperative day 10, melena was observed, and CT revealed partial thickening of the small intestine and a decrease in the contrast effect. Considering the post-total colectomy and general condition, we proceeded with conservative treatment. Over time, the patient developed liver and renal dysfunction and died 16 days after surgery. Conclusions We experienced a case of NOMI caused by bleeding from a pelvic fracture. It is important to keep in mind the risk of developing NOMI in traumatic bleeding to avoid missing this diagnosis.

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Superselective internal iliac arterial embolization for severe hemorrhage following radical prostatectomy

Oncology Letters ◽

10.3892/ol.2012.749 ◽

2012 ◽

Vol 4 (3) ◽

pp. 521-523 ◽

Cited By ~ 4

Author(s):

SHENG CHENG ◽

LIWEI XU ◽

GONGHUI LI ◽

YUEBING CHEN ◽

HONGJIE HU ◽

...

Keyword(s):

Radical Prostatectomy ◽

Arterial Embolization ◽

Severe Hemorrhage ◽

Internal Iliac

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Resuscitative Endovascular Balloon Occlusion of the Aorta is a Risk Factor for Intestinal Necrosis: A Case Report

10.21203/rs.3.rs-102623/v1 ◽

2020 ◽

Author(s):

Keitaro Yajima ◽

Shokei Matsumoto ◽

Motoyasu Yamazaki

Keyword(s):

Case Reports ◽

Severe Trauma ◽

Balloon Occlusion ◽

Trauma Patients ◽

Occlusion Time ◽

Intestinal Necrosis ◽

Ischemic Complications ◽

Inappropriate Utilization ◽

Enhanced Computed Tomography ◽

Endovascular Balloon Occlusion

Abstract BackgroundResuscitative endovascular balloon occlusion of the aorta (REBOA) is effective for temporary hemorrhage control and resuscitative effort, as it enhances cerebral and coronary circulation in trauma patients. However, an inappropriate utilization of REBOA leads to critical complications. Placement of the balloon in Zone 2 of the aorta should be avoided as the occlusion restricts the intestinal blood supply leading to fatal complications. There is a scarcity of case reports on complications associated with endovascular balloon occlusion in the literature. Here, we have presented a rare case in which Zone 2 REBOA contributed to an ischemic complication in a trauma patient.Case presentationA 50-year-old man with severe trauma, who accidentally got buried under a fallen cement wall, was carried to the nearest hospital. Contrast-enhanced computed tomography showed an unstable pelvic fracture that required hemostatic intervention. Prior to being transferred to another hospital, the patient was treated with endovascular balloon placement. A Zone 2 endovascular balloon placement with resuscitative effort accidentally led to insufficient abdominal blood flow and he developed extensive intestinal necrosis. Following surgical intervention, the patient was resuscitated; however, he developed partial intestinal necrosis and was subsequently managed with surgical intestinal resection.ConclusionsBlood supply to the abdominal organs should be considered when deploying the balloon. Further, balloon positioning, aortic occlusion time, and inflation volume should be carefully considered to avoid ischemic complications.

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Spontaneous Retroperitoneal Hematoma: a Case Report, Review of Literature, and Proposal of Diagnostic and Management Algorithm

10.21203/rs.3.rs-958926/v1 ◽

2021 ◽

Author(s):

Takuma Kurotaki ◽

Naoya Okada ◽

Yasuo Sakurai ◽

Takumi Yamabuki ◽

Minoru Takada ◽

...

Keyword(s):

Conservative Management ◽

Arterial Embolization ◽

Retroperitoneal Hematoma ◽

Close Monitoring ◽

Treatment Timing ◽

Management Algorithm ◽

Abdominal Aortic ◽

Contrast Enhanced ◽

Severe Hypotension ◽

Enhanced Computed Tomography

Abstract Background: Spontaneous retroperitoneal hematoma (SRH) is defined as bleeding in the retroperitoneal space without any triggers such as trauma, invasive procedures, and abdominal aortic aneurysm. Case presentation: A 48-year-old man who experienced sudden abdominal pain, severe hypotension, and decreased hemoglobin (Hb) was diagnosed with SRH. Contrast-enhanced computed tomography (CT) revealed massive left retroperitoneal hematoma; however, neither extravasation nor causative aneurysm was noted. Through conservative management with close monitoring, he was treated and discharged on the 10th hospital day without any morbidity. Conclusions: SRH treatment comprises conservative management, transcatheter arterial embolization, and surgical intervention. The mortality rate of SRH is so high that the optimal treatment timing needs to be carefully judged based on detailed evaluation and management algorithm with clear criteria.

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Internal Iliac Artery Embolization for the Control of Severe Bladder Hemorrhage Secondary to Carcinoma: Long-Term Follow-Up

The Scientific World JOURNAL ◽

10.1100/tsw.2007.229 ◽

2007 ◽

Vol 7 ◽

pp. 1567-1574 ◽

Cited By ~ 14

Author(s):

Ahmed El-Assmy ◽

Tarek Mohsen

Keyword(s):

Iliac Artery ◽

Internal Iliac Artery ◽

Arterial Embolization ◽

Artery Embolization ◽

Severe Hemorrhage ◽

Long Term Follow Up ◽

Internal Iliac ◽

Internal Iliac Artery Embolization

The purpose of this study was to evaluate the efficacy and long-term complications of internal iliac artery embolization as a palliative measure in the control of intractable hemorrhage from advanced bladder malignancy. From January 1998 through December 2005, seven patients underwent transcatheter arterial embolization (TAE) of anterior division of internal iliac artery bilaterally for intractable bladder hemorrhage. After embolization, patients were followed for the efficacy of the procedure in controlling hematuria and complications. TAE was successful in immediate control of severe hemorrhage in all seven patients after a mean period of 4 days. At a mean (range) follow-up of 10 (6–12) months, the hemorrhage was permanently controlled in four (57%) patients. Three patients developed hematuria and required emergency admissions; two had mild hematuria and were managed conservatively, and the remaining one required a second attempt of embolization after 2 months from the first one. During the whole period of follow-up, there were no significant complications related to embolization. Internal iliac artery embolization is an effective and minimally invasive option when managing advanced bladder malignancies presenting with intractable bleeding. The long-term follow-up showed control of bleeding in the majority of such patients with no serious complications.

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A Case of Intestinal Necrosis after Bilateral Internal Iliac Artery-Preserving Endovascular Repair for Abdominal Aortic Aneurysm

Annals of Vascular Diseases ◽

10.3400/avd.cr.16-00028 ◽

2016 ◽

Vol 9 (3) ◽

pp. 240-243 ◽

Cited By ~ 1

Author(s):

Tomomi Nakajima ◽

Masataka Sato ◽

Akito Imai ◽

Yasunori Watanabe

Keyword(s):

Abdominal Aortic Aneurysm ◽

Aortic Aneurysm ◽

Iliac Artery ◽

Endovascular Repair ◽

Internal Iliac Artery ◽

Intestinal Necrosis ◽

Abdominal Aortic ◽

Internal Iliac

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Use of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) as a bridge to endovascular aortic repair (EVAR) in blunt abdominal aortic injury (BAAI).

Journal of Endovascular Resuscitation and Trauma Management ◽

10.26676/jevtm.v3i1.74 ◽

2019 ◽

Vol 3 (1) ◽

Author(s):

Valentina Chiarini

Keyword(s):

Trauma Center ◽

Aortic Rupture ◽

Damage Control ◽

Aortic Injury ◽

Balloon Occlusion ◽

Traumatic Lesion ◽

Abdominal Aortic ◽

Aortic Injuries ◽

Accepted Practice ◽

Endovascular Balloon Occlusion

BAAI is a rare but challenging traumatic lesion. Since BAAI is difficult to suspect and diagnose, frequently lethal and associated to multiorgan injuries, its management is objective of research and discussion. REBOA is an accepted practice in ruptured abdominal aortic aneurysm. Conversely, blunt aortic injuries are the currently most cited contraindications for the use of REBOA in trauma, together with thoracic lesions. We reported a case of BAAI safely managed in our Trauma Center at Maggiore Hospital in Bologna (Italy) utilizing REBOA as a bridge to endovascular repair, since there were no imminent indications for laparotomy. Despite formal contraindication to placing REBOA in aortic rupture, we hypothesized that this approach could be feasible and relatively safe when introduced in a resuscitative damage control protocol.

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