A Case of Simultaneous Onset of Intra-abdominal Bleeding and Common Iliac Artery Occlusion due to Abdominal Trauma, which Could Be Saved and Attained Limb Salvage by Simultaneous Surgery of Abdominal Opening and Lower Limb Bypass after Creation of an External Shunt

Abstract

The case was a 77-year-old man. His abdomen was pinched by a 2-ton iron pillar. Computed tomography showed intra-abdominal hematoma and the right common iliac artery occlusion, and he was transferred to our hospital for treatment. We decided that intra-abdominal hemostasis was necessary prior to revascularization surgery. Considering that it would take time before reperfusion, we made an external shunt at the emergency outpatient department and started lower limb perfusion. The surgery was performed by opening the abdomen and stopping bleeding only, and the treatment for the intestinal tract was done after revascularization of the lower limbs. The exposed right femoral artery was occluded by dissection, left and right femoral artery crossover bypass surgery was performed. After that, we excised the injured part of the small intestine, and removed the external shunt. The postoperative course was good, and the arteries of both lower limbs were well visualized by CT, and the patient was able to walk by rehabilitation. In a case of simultaneous onset of intra-abdominal bleeding and common iliac artery occlusion due to abdominal trauma, we constructed an external shunt prior to surgery and then performed simultaneous surgery of abdominal opening and lower limb bypass. We saved his life and attained limb salvage without reducing his ADL.