Internal pudendal pseudoaneurysm complicating an ischial pressure sore

Pseudoaneurysm of the internal iliac artery caused by proximal femoral nail antirotation following intertrochanteric fracture: a case report

Pseudoaneurysm of the internal iliac artery is a very rare complication of intertrochanteric fracture. Here, the case of an 88-year-old female patient, who presented with intense pain following surgery for intertrochanteric fracture of the femur, is reported. Radiography revealed intertrochanteric fracture of the left femur fixed by proximal femoral nail antirotation (PFNA). The PFNA was found to have disassembled, and the screw had penetrated through the acetabulum. As computed tomography (CT) revealed a haematoma behind the acetabulum, CT angiography was immediately performed. A pseudoaneurysm of the internal iliac artery caused by PFNA was revealed. Percutaneous endovascular treatment of the pseudoaneurysm was undertaken on an urgent basis. Three days later, the PFNA was removed, and the fracture was reduced and fixed with locking proximal femoral plate. The patient's pain was significantly reduced following this corrective surgery. This case illustrates that substandard PFNA surgery for intertrochanteric fracture may result in pseudoaneurysm of the internal iliac artery.

Treatment of internal iliac artery pseudoaneurysm by an endovascular approach

Pseudoaneurysms of the internal iliac artery are uncommon and are usually associated with trauma. We report the case of a 32-year-old man with a 15-day history of trauma to the abdomen and edema of the lower left limb. An arteriogram demonstrated proximal occlusion of the popliteal artery and a pseudoaneurysm in the internal iliac artery. Embolization of the pseudoaneurysm was performed using segments of guide wire that occluded the pseudoaneurysm, followed by proximal occlusion, which was accomplished using coils. An arteriogram after the procedure revealed adequate occlusion of the lesion. This association of guide wires and coils is a treatment option in cases of pseudoaneurysm of the internal iliac artery with large volumes needing to be occluded.

Pressure ulcers

Pressure ulcers are localized areas of tissue necrosis that result from unrelieved pressure. They are graded or staged according to the degree of tissue damage observed. The main etiologic factors include pressure, shearing forces, friction, and moisture. The clinical course may be complicated by several conditions including infection, sepsis, osteomyelitis, fistulas, and carcinoma. Preventive measures in persons at risk can significantly reduce the incidence of pressure ulcers. Successful management should address the four etiologic factors as well as the general condition of the patient.