Maraqa Tareq I, Shin Ji-Sun J, Diallo Ismael, Sachwani-Daswani Gul R, Mercer Leo C
Trauma Department, Hurley Medical Center, Michigan State University.
Hurley Medical Center, Michigan State University.
Cureus. 2017 Nov 17;9(11):e1857. doi: 10.7759/cureus.1857.
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. 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.
盆腔枪伤导致的闭孔动脉损伤（OAI）是一种鲜有报道的情况。盆腔创伤（PT）引起的出血大多为静脉性出血。动脉出血约占PT的10%-20%。当PT出现动脉出血时，这是一种严重且致命的并发症，常导致显著的血流动力学不稳定并最终引发休克。一名23岁男性乘坐私家车被送往我们的急救中心，其双大腿和下背部多处枪伤，导致直肠和闭孔动脉（OA）损伤。该患者成功接受了右侧OA的线圈栓塞术。鉴于盆腔内结构的密集程度，盆腔区域遭受枪伤的患者小肠、乙状结肠、直肠、膀胱和/或血管结构受伤的风险很高。虽然出血是PT早期死亡的主要原因，但直肠损伤因内脏损伤导致的死亡率最高。诊断髂动脉损伤或其分支损伤需要高度的临床怀疑指数。及时进行计算机断层血管造影（CTA）并栓塞OA是控制和止血以及改善死亡率结局的最佳方法。照顾盆腔枪伤患者的临床医生应注意闭孔动脉内出血的延迟表现。多学科团队方法对于成功处理闭孔动脉穿透伤至关重要。
