Subcutaneous cross pelvic bypass associated with occluded iliac veins.

Abstract

Pelvic venous anomalies can be manifested with a number of symptoms. A 22-year-old man presented to his local emergency department after a bicycle accident associated with direct blunt trauma to the left groin. He complained of left groin pain and was noted to have a left groin lump. On careful questioning, there may have been a lump in the left groin before the accident, but it was thought that the lump was now bigger. His past medical history was unremarkable apart from meconium aspiration as a neonate. No medical records are available for this episode, but the patient reports that he was very unwell in an intensive care unit. On clinical examination, there was a soft, lobulated lump in the left groin and suprapubic region. There was no associated thrill. The left leg calf circumference was 2 cm larger than the right, but otherwise peripheral pulses were normal, there were no signs of varicose veins, and there were no skin changes of venous hypertension. Computed tomography with intravenous administration of contrast material in the leg venous phase was performed with three-dimensional reconstructions (A). This showed an abnormal dilated, tortuous vein extending from the left saphenofemoral junction, across the suprapubic region, and joining the right saphenofemoral junction. In B, the lateral view demonstrates the subcutaneous bulge nature of the lesion. Imaging of the pelvic veins demonstrates an absence of the left external and common iliac veins (C). There do not appear to be any other major venous collaterals. We find it difficult to know if this lesion is congenital or acquired. It is possible that as an unwell neonate, he may have had venous access through a left femoral vein catheter. We have elected to manage this condition conservatively. Another case with similar computed tomography imaging has been reported in which the iliac vein was treated by angioplasty and stent placement. No long-term follow-up was reported.