2021 Volume 30 Issue 1 Pages 53-56
An 80-year-old man who had been stepped on his lower abdomen by a cow, showing paleness, coldness, and pain on his right leg was delivered to nearby hospital. He was transported to our hospital and arrived at 6 hours after the injury. No pulse was palpable on the right femoral and peripheral arteries and the right lower limb was paralyzed. CTA revealed obstructions from the right common iliac artery to the external iliac artery and the superficial femoral artery. A femoro–femoral bypass and thrombectomy for the right superficial femoral artery were performed immediately. Dorsal and posterior tibial arteries become palpable after surgery. Obvious swelling of the right lower leg appeared 6 hours after surgery and fasciotomy was performed. The urine volume was 1600 mL/day on the 1st postoperative day, but myonephritic metabolic syndrome (MNMS) was diagnosed on the 3rd postoperative day based on the depleted urine (400 mL/day) and the lab data (BUN 87.7 mg/dL, Cr 7.8 mg/dL, K 5.9 mEq/L), and hemodialysis (HD) was begun. The patient could leave HD 5 weeks later. The wounds of fasciotomy were treated with vacuum assisted closure therapy and skin grafting. He recovered to walk and discharged at 6 weeks after the operation. Iliac artery obstruction due to blunt trauma is relatively rare. It is not rare to be able to save a limb which is classified the Rutherford category III, however special attention is required to predict the onset of MNMS in such cases.
