A Rare Case Report of Penetrating Trauma Induced Inferior Epigastric Artery Pseudo aneurysm and Laparoscopic Ligation of Feeder Vessel
Journal Title: International Journal of Medical Science and Innovative Research (IJMSIR) - Year 2018, Vol 3, Issue 2
Abstract
Background: A 35-year-old male came to casualty with complain of swelling in the left infra-umbilical region. Upon enquiry he had sustained a stab wound of around 1*1 cm by metallic rod in the left infra-umbilical region. The swelling was painful on palpation and not associated with any cough impulse. The swelling was fluctuant, pulsatile, non reducible in nature. Thrill was present on palpation. USG showed a 3.2*1.1*1.4 cm sized anechoic region, with typical Yui-Yau type of flow within it on Doppler. The anechoic region was seen communication with the adjacent left inferior epigastric artery. CT Angiography of the lower limb revealed intensely enhanced focal out pouching of left inferior epigastric artery with leakage of contrast on subsequent delayed phase suggestive of actively bleeding pseudo aneurysm of Inferior epigastric artery. Methods & Results: Intra-corporeal laparoscopic ligation of the feeder vessel at the junction of origin from the left external iliac artery. Two-point ligation was done for the feeder vessel, which was inferior epigastric artery, abdominal wall hematoma was evacuated, drain was put and the patient was discharged vitally stable. Discussion: Pseudo-aneurysms may develop after any procedure that causes breach in a portion of the vessel wall. In this case the pseudo-aneurysm developed at the site as a result of a penetrating stab injury, clinical manifestations initially suggested hematoma, however CECT aortography revealed to be an actively bleeding pseudo-aneurysm. Awareness among specialists and general medical practitioners is beneficial to avoid increased patient morbidity following an abdominal wall procedure or injury.
Authors and Affiliations
Mittal Amol
Keywords
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