Wee James, Lua Wensheng, Louange Danny Thomas
Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore 308433, Singapore.
Adj Asst Prof, Tan Tock Seng Hospital, 11, Jalan Tan Tock Seng, Singapore 308433, Singapore.
J Clin Orthop Trauma. 2013 Jun;4(2):98-101. doi: 10.1016/j.jcot.2013.03.004. Epub 2013 Mar 30.
We report a case of a 73-year-old man with a background of aspirin use who fell and sustained a minimally displaced right superior pubic ramus fracture. He subsequently developed hypotension that necessitated fluid resuscitation, associated with a significant drop in blood haemoglobin levels that required a packed red blood cell transfusion. CT scans revealed the presence of two pelvic haematomas, with ongoing bleeding. An angiogram demonstrated bleeding from the superior vesical branch of the anterior division of the right internal iliac artery, which was successfully embolised with gelfoam slurry. The patient recovered uneventfully thereafter. This is a unique case involving an unexpected injury to the superior vesical branch of the anterior division of the internal iliac artery following low energy trauma to an elderly man. We recommend that patients who develop hypotension following a seemingly-benign isolated pubic ramus fracture be evaluated for concomitant arterial injuries with the relevant CT imaging and angiography.
我们报告一例73岁男性病例，该患者有服用阿司匹林史，摔倒后导致右侧耻骨上支骨折，移位轻微。随后他出现低血压，需要进行液体复苏，同时血红蛋白水平显著下降，需要输注浓缩红细胞。CT扫描显示有两个盆腔血肿，且出血仍在继续。血管造影显示右侧髂内动脉前干的膀胱上支出血，用明胶海绵糊剂成功栓塞。此后患者顺利康复。这是一例独特的病例，涉及一名老年男性在低能量创伤后髂内动脉前干膀胱上支意外受伤。我们建议，对于看似良性的孤立耻骨支骨折后出现低血压的患者，应通过相关CT成像和血管造影评估是否伴有动脉损伤。
