This is a 27-year-old female patient who, as a result of a high speed frontal collision in a motor vehicle, suffered severe polytrauma.
When she was assisted she was wet and wearing a seat belt.
Washing right in place of the accident nearest hospital, where it was found a picture of shock and acute abdomen, so you underwent emergency exploratory laparotomy, finding a rectal muscle cavity abdominal section
Subsequently, he arrived at another center of greater complexity twelve hours after the trauma.
In the initial evaluation, the patient was wet, presented coldness of both lower limbs with functional impotence, lack of sensitivity (anesthesia) and absence of femoral and distal pulses.
The requested studies evidenced burst fracture of the right helix head, fracture of the middle third of the right diaphysis hump, dr fracture of the right diaphysis diaphysis, and pneumothorax degree I.
Magnetic resonance imaging of the lumbosacral spine ruled out spinal cord injuries, finding a sacral fracture as the only lesion.
After initial resuscitation, abdominal CT with intravenous contrast was performed, ruling out solid organ lesions.
No abnormalities were observed at the aortic level, but due to the semiology, angiography of the abdominal aorta and lower limbs was performed, which demonstrated infrarenal aortic occlusion without distal circulation.
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With the diagnosis of post-traumatic abdominal aortic occlusion, it was decided to perform vascular surgery (15 hours after the accident).
The surgical technique consisted of aortic thrombectomy with Fogarty catheter, under visual and manual control of the abdominal aorta, plus distal embolectomy of the common femoral arteries.
In laparotomy to approach the aorta, hypoperfusion of the small intestine was found, which was interpreted as the compromise of the flow branches of the aorta inferior mesenteric artery secondary to thrombosis.
This picture reverted after the intervention.
At 24 hours, the patient met criteria for acute respiratory distress syndrome secondary to pulmonary contusion and signs of ischemia on right side of the patellar trunk. The patient was reoperated on and underwent embolectomy.
Despite this procedure, signs of distal ischemia were interpreted as secondary to distal barium.
The possibility of performing thrombolytic treatment for previous surgeries was ruled out.
Intraoperative arteriography showed patency of the anterior tibial and tibioperoneal trunk branches.
The signs of ischemia remained, accompanied by ascending metabolic acidosis and thrombocytopenia due to consumption, so it was decided to perform an infra-Rotulian amputation of compromised thrombocytopenia, a maneuver that corrected changes in the internal environment.
The patient was discharged from the unit after 25 days.
