Open pelvic fracture with bilateral common iliac arteriovenous injury successfully treated with hemicorporectomy following damage control interventional radiology in a hybrid emergency room

Abstract

Background: In severe pelvic fracture, keys of successful treatment are early hemostasis and timely definitive care. We present a case in which the patient was treated by fast and reliable hemostasis and subsequent comprehensive hemicorporectomy.

Case presentation: We describe the case of a 47-year-old man with severe pelvic trauma. He received early intervention by the helicopter emergency medical service, which included rapid transarterial embolization as damage control interventional radiology in the hybrid emergency room, and hemicorporectomy as a multidisciplinary approach. This series of treatments saved his life and he was discharged home.

Conclusion: Hemicorporectomy could be the only treatment option in patients with severe pelvic injury when there are no reconstruction options. To the best of our knowledge, this is the first case of severe open pelvic fractures with blood vessel damage, successfully treated by initial hemostasis using the helicopter emergency medical service, hybrid emergency room system, and following hemicorporectomy as a definitive care.

Keywords: Helicopter emergency medical service; hemorrhagic shock; hemostasis; transcatheter arterial embolization; trauma pan scan.

Fig. 1

Photographs and illustrations of the workplace accident in which a 47‐year‐old man suffered severe pelvic trauma. A, B, Photographs of the accident scene, showing the patient’s left hip and right thigh trapped by the wood processing machine. C, Illustration showing a top view of the accident scene. D, Illustration showing the patient’s left foot trapped by the machine. The processing machine can slide on the table.

Fig. 2

Severe pelvic trauma in a 47‐year‐old man. Left panel, A deep tear is seen from the right lumbar region to the left thigh, through the groin and perineal area. Arrow, exposed right external iliac artery with a Nelaton catheter tourniquet; arrowhead, exposed left external iliac artery with an arterial access. Right panel, 3‐D computed tomography image shows multiple pelvic fractures and bilateral femur fracture.

Fig. 3

Clinical course timeline from the accident causing severe pelvic trauma in a 47‐year‐old man. Numbered events with arrowheads are indicated with the legends in the white box. DBP, diastolic blood pressure; HEMS, helicopter emergency medical service; HER, hybrid emergency room; HR, heart rate; OR, operating room; SBP, systolic blood pressure; TAE, transcatheter arterial embolization; Trans, transportation.

Fig. 4

Severe pelvic trauma in a 47‐year‐old man. Except for part of the right buttock, the pelvic bone and surrounding muscles were totally necrotic.

Fig. 5

Photographs of surgical intervention in a 47‐year‐old man with severe pelvic trauma. Top left panel, Intraoperative photograph taken with the patient in the prone position. The lumbar pedicle is removed and the dura is exposed, ligated, and then cut (arrow). Top right panel, Large vessels are exposed when the necrotic pelvic muscles are mobilized. 1, right common iliac artery; 2, left ureter; 3, left common iliac vein. Bottom panel, Photograph after pelvic resection.