Citation

Maraqa TI, Shin JJ, Diallo I, Sachwani-Daswani GR, Mercer LC. Cureus 2017; 9(11): e1857.

Affiliation

Trauma and Acute Care Surgery, Hurley Medical Center.

Copyright

(Copyright © 2017, Curēus)

DOI

10.7759/cureus.1857

PMID

29375943

PMCID

PMC5773274

Abstract

Obturator artery injury (OAI) from pelvic gunshot wounds (GSW) is a rarely reported condition. Hemorrhages from pelvic trauma (PT) are mostly venous. Arterial hemorrhages represent about 10-20% of PTs. When arterial hemorrhages from PT occur, they are a severe and deadly complication often causing significant hemodynamic instability and eventual shock. A 23-year-old male presented to our emergency service via a private vehicle with multiple gunshot wounds to both thighs and to the lower back, resulted in rectal and obturator artery (OA) injuries. The patient underwent a successful coil-embolization of the right OA. Given the density of structures within the pelvis, patients who sustain gunshot wounds to the pelvic region are at high risk for injury to the small bowel, sigmoid colon, rectum, bladder, and/or vascular structures. While bleeding is the major cause of early mortality in PT, rectal injuries carry the highest mortality due to visceral injuries. A high clinical index of suspicion is needed to diagnose an iliac artery injury or injury to its branches. Prompt computed tomographic angiogram (CTA) and embolization of the OA is the best method to control and stop the bleeding and improve the mortality outcome. Clinicians caring for patients presenting with pelvic gunshot wounds should pay attention to the delayed presentation of internal hemorrhage from the OAs. A multidisciplinary team approach is crucial in the successful management of penetrating injuries to the obturator artery.

Language: en

Keywords

embolization of the obturator artery; gunshot wound; internal iliac branches injury; obturator artery; pelvic trauma; penetrating obturator artery injury; penetrating pelvic injury; penetrating vascular injury