Delayed Presentation of Traumatic Acute Limb Ischemia

Abstract

Acute limb ischemia is defined as sudden cessation of limb perfusion that threatens the viability of the limb. Although uncommon, acute limb ischemia can present with severe symptoms. We present the case of a 23-year-old male who was admitted for treatment of abdominal gunshot injury. Laparotomy revealed multiple transections of the small bowel with a non-expanding zone 2 retroperitoneal hematoma. Following resection of the damaged bowel, 12 hours postoperatively, the patient complained of right lower limb numbness. Examination revealed absent right femoral, popliteal, dorsalis pedis and posterior tibial pulses, with a capillary refill time (CRT) of 3 seconds. Computed tomography arteriogram (CTA) showed right external iliac artery thrombosis, with reconstitution of flow in the distal external iliac artery. Repeat laparotomy showed a peri-arterial hematoma of the right external iliac artery distal to the common iliac bifurcation. We removed a 3 cm thrombus from the right external iliac artery and performed an interposition graft. Following surgery, all the lower limb pulses were palpable and the patient was discharged in good condition on postoperative day 6. Delayed presentation of acute limb ischemia is possible in the setting of trauma, and should be kept in mind, as timely intervention is important for limb salvage with good outcome.