Leriche Syndrome Diagnosed Due to Polytrauma: a Case Report

Background: Leriche syndrome is caused by atherosclerosis and is often characterized by symptoms such as intermittent claudication as well as numbness and coldness of the lower limbs. Its exact prevalence and incidence are unknown because it is a rare disease. We report a case of Leriche syndrome diagnosed incidentally on a trauma pan-scan computed tomography (CT).Case Presentation: A 61-year-old Asian man was driving a passenger car when he had a head-on collision with a dump truck and received an emergency call. He was transported to our hospital in a doctor's helicopter. Physical examination revealed the following vital signs: respiratory rate, 23 breaths per minute; SpO2, 98% under a 10 L administration mask; pulse rate, 133 beats per minute; blood pressure, 142/128 mmHg; Focused Assessment with Sonography for Trauma, positive; Glasgow Coma Scale E3V5M6; and body temperature, 35.9℃.Trauma pan-scan CT showed bilateral mandibular fractures, bilateral multiple rib fractures, bilateral pneumothorax, sternal fractures, peri-thoracic hematoma, small bowel perforation, mesenteric injury, right clavicle fracture, right ankle debridement injury, and thrombotic occlusion of the bilateral common iliac arteries from just above the abdominal aortic bifurcation. Although thrombotic occlusion needed to be differentiated from traumatic aortic injury, the presence of collateral blood vessels led to the diagnosis of Leriche syndrome, and conservative treatment was performed.Damage control surgery was required for small bowel injuries. From the second day of admission, the patient was treated with continuous intravenous heparin and prostaglandin preparations. However, impaired blood flow and reperfusion injury in the right lower extremity progressed. On the fifth day of admission, right thigh amputation was performed. The patient required renal replacement therapy for approximately two weeks starting from the third day of admission.Conclusions: In this case, conservative therapy was initially chosen as the treatment for Leriche syndrome. However, the complex factors in the acute phase of trauma lead to hemorrhagic necrosis development, resulting in amputation of the lower extremity. Our findings making necessitate the importance of decision of treatment indication and choice.