Coste M, Yoon D, Noory M, Roudnitsky V. Superior gluteal artery pseudoaneurysm after a gunshot wound to the buttock: A case.
Int J Surg Case Rep 2020;
77:341-344. [PMID:
33212307 PMCID:
PMC7683236 DOI:
10.1016/j.ijscr.2020.11.016]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2020] [Revised: 10/31/2020] [Accepted: 11/02/2020] [Indexed: 11/05/2022] Open
Abstract
Gunshot and stab wounds are common causes of penetrating trauma to the buttock.
Penetrating trauma to the upper zone of the buttock can result in vascular injury.
Pseudoaneurysms are rare complications of traumatic arterial injuries.
Pseudoaneurysms can be treated with embolization.
There are no guidelines for screening of gluteal pseudoaneurysms after trauma.
Introduction
Penetrating trauma to the buttock can rarely result into the development of a gluteal artery pseudoaneurysm. Here we present the case of a patient with a superior gluteal pseudoaneurysm after a gunshot wound to the left buttock.
Presentation of case
A 48-year-old male presented with fullness and tenderness at the left gluteal wound that resulted from a gunshot 18 days prior. At the time of initial trauma, imaging showed minimal extravasation of contrast at the left superior gluteal artery, but the bleeding stopped and patient was discharged. On his return, examination showed palpable fluctuance but no bleeding. A superior gluteal artery pseudoaneurysm was identified on CT scan. Patient also complained of intermittent subjective fever and new onset of SOB. CT chest demonstrated a pulmonary embolism at the right basilar segmental artery. Coil embolization was performed to treat the pseudoaneurysm and patient was subsequently started on anticoagulation therapy.
Discussion
Penetrating wounds to the buttock can result in associated vascular or visceral injuries. Pseudoaneurysms can develop days to years after the initial injury. On exam, presence of pain, swelling, tenderness, bleeding from wound, thrill, bruit or a pulsating mass should raise suspicion for pseudoaneurysm, which can be diagnosed on CT scan and treated with embolization.
Conclusion
Proper management of traumatic wounds to the buttock with associated vascular injuries, with follow up protocols and patient education is necessary to prevent life-threatening complications such as hemorrhage from pseudoaneurysm.
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