Spontaneous iliac vein rupture: case report and literature review

Spontaneous rupture of the iliac vein is a rare cause of exsanguinating haemorrhage. A case is described of a 66 year old woman who required immediate resuscitation in Accident and Emergency following a 24 hour history of left leg and lower quadrant abdominal pain. Emergency laparotomy revealed a 2 cm tear in the left iliac vein. The previously reported cases are reviewed, together with discussion of the patterns of presentation and possible underlying causes.     

Spontaneous rupture of the left common iliac vein

A 63-year-old woman was admitted because she presented with acute lower abdominal pain and left leg pain without any history of trauma. Lower extremity venous duplex ultrasound demonstrated deep vein thrombosis in the left lower extremity. Computed tomography scan revealed high-density, irregular clumps in the pelvic region and a soft-tissue mass shadow in the right lower abdomen. Emergency laparotomy revealed a 1.5-cm longitudinal tear in the left common iliac vein. The vein was repaired primarily and the postoperative course was uneventful.     

自发性髂静脉破裂:病例报告兼文献复习

目的:分析自发性髂静脉破裂的诊断与外科治疗。方法:报告本院2003年收治的1例左髂外静脉自发性破裂病例,并检索国内外相关文献,取其中资料完整的24篇文献,共26例病人(包括本例病人),对其临床表现、影像学检查、病理学检查、手术方式和预后进行分析。结果:女24例,男2例。突发下腹部疼痛或饱胀(25/26)、下肢肿胀(8/26)为主要症状,24例存在休克。发生于左侧髂静脉(24/26),仅2例发生于右侧髂外静脉。影像学检查显示为髂窝混合性肿块。22例接受破裂静脉壁修补,4例行髂静脉结扎。8例病理学检查无明显异常。21例存活,5例死亡。结论:突发下腹部肿块或疼痛、休克且无外伤史的女性病人,为该病的诊断要点。积极复苏、及时剖腹探查和破裂静脉壁修补可取得较好预后。     

Spontaneous rupture of the iliac vein: Report of a case

We reprot a rare case of a spontaneous rupture of the iliac vein which was then surgically treated with good results. A 66-year-old woman was admitted complaining of leg swelling and lower abdominal pain. On the 3rd day after admission, an operation was performed because of a gradually increasing hematoma in the retroperitoneal space. Laparotomy revealed a 17 mm longitudinal tear on the anterior surface of the left external iliac vein with a thrombus inside the lumen. Most of the previously reported 14 cases of this nature have required emergency operations.     

Spontaneous rupture of the iliac vein

Two unusual cases of iliac vein spontaneous rupture into the retroperitoneum are presented together with 18 cases reported by the literature. In one patient of ours, entrapment of clots in an IVC filter and proximal iliac vein involvement into the scar tissue surrounding the left limb of an aortoiliac bifurcation graft might have caused flow disturbances and subsequent predisposition to rupture of the thrombosed external iliac vein. Inflammatory parietal changes, including infiltration of macrophages, T and B lymphocytes producing elastin degradation by means of cytokines, may have led ultimately to vein disruption. Despite clinical features and CT scan findings, the physician's awareness of this disease remains the most important factor for the early treatment.     

Spontaneous rupture of an iliac vein.

A 67 year old female was seen as an emergency some three days following a minor fall with spontaneous rupture of the left iliac vein. Emergency surgery consisted of repair of the venous rent, compartmentation of the vena cava, thrombectomy, and subsequently anticoagulation. Etiology of the rupture was considered to be the thrombosis in the proximal portion of the iliac vein which created a high venous pressure behind the thrombus.     

Spontaneous rupture of the common carotid artery: a case report.

Spontaneous rupture of the common carotid artery is an extremely rare vascular disorder in the head and neck region. Pseudoaneurysm can be formed by arterial rupture, presenting clinically as an expanding mass lesion. A 37-year-old fisherman suffered from the spontaneous rupture of the left common carotid artery and resultant pseudoaneurysm was radiologically recognized. Surgical exploration revealed a 0.5-cm rent in the common carotid artery, 2 cm proximal to the bifurcation. The lesion was successfully managed with polypropylene sutures during temporary clamping of the carotid artery. The literature is reviewed and the principles of management are discussed.     

Spontaneous rupture of the right external iliac vein

Spontaneous rupture of an iliac vein is a very rare condition, with 34 reported cases in the previously published data and only two cases involving the right side. We report the third case of spontaneous rupture of the right external iliac vein. A 62-year-old woman presented with sudden onset of lower abdominal pain and an inability to move the right lower extremity shortly after stretching her right leg backward. A contrast computed tomography demonstrated a massive pelvic retroperitoneal hematoma and a thrombus extending from the inferior vena cava to the right iliac veins. An inferior vena cave filter was inserted using interventional radiology, followed by an exploratory laparotomy. A 1.5-cm laceration in the right external iliac vein was uncovered and repaired. The etiology, clinical features, and treatment of spontaneous iliac vein rupture are discussed.     

Spontaneous tracheal rupture: a case report

We report the case of a spontaneous posterior tracheal wall rupture following a cough. A 67-year-old woman with a history of longstanding treatment with corticosteroids (8 years) for Giant Cell Arteritis had general anesthesia for cataract removal. Surgery and anesthesia were uneventful. In the recovery room, the patient coughed and soon after developed subcutaneous emphysema of the neck. Chest radiography confirmed the clinical diagnosis of marked subcutaneous emphysema and showed huge pneumomediastinum and minor right pneumothorax. A thoracic CT scan revealed a large laceration of the posterior tracheal wall (a 4 cm longitudinal tear), extending from the middle of the trachea to the level of the carina. Surgical repair consisted in closure of the dilaceration using an autologous pericardial patch. It seems reasonable to suspect the facilitating role of connective tissue fragility due to chronic corticosteroid administration in the development of this tracheal rupture following cough. Tracheal rupture is a potentially lethal injury, which can be repaired successfully if the diagnosis is made early. Risk factors, diagnosis and principles of treatment of this lesion are discussed.     

Spontaneous dissection of common iliac artery. A case report

Spontaneous dissection of the iliac artery is very rare but known as a complication of high-energy traumatic injuries and has been reported in connection with pregnancy, collagen diseases, and alpha-1-antitrypsin deficiency. The authors report a 42-year-old man with an acute dissection of the common iliac artery during exercise. Groin pain and claudication were the early symptoms. Computerized angiotomography was diagnostic. Operative iliac artery reconstruction was performed. A prerelease control computed tomography examination showed a dissection of the distal aorta and left iliac artery. To their knowledge, the combination of the 2 dissections has not been previously published.     

Spontaneous common iliac arteriovenous fistula manifested by acute renal failure: a case report

Arteriovenous fistulas between the common iliac vessels resulting from spontaneous rupture of aneurysms are rare, with only 31 cases having been reported since 1971. Clinical diagnosis is possible when a unique set of findings is present, namely high-output cardiac failure, a pulsatile abdominal mass associated with a bruit or thrill, and unilateral arterial insufficiency or venous engorgement. Recently, with advancements in diagnostic techniques, the number of cases in which an arteriovenous fistula is found between the common iliac vessels has increased. Diagnosis can be difficult, however, as in the case of one of our patients in whom the predominant sign was acute renal failure. Other reports of renal failure or impairment in the presence of a common iliac fistula have also appeared. Awareness of this phenomenon can help the physician to establish the diagnosis when one or more of the classic signs are absent. Prompt diagnosis and surgical management have contributed to the high incidence of survival in patients with arteriovenous fistulas between the common iliac vessels.     

Spontaneous rupture of left external iliac vein: Case report and review of the literature

Iliac vein rupture is rare and primarily results from major trauma or occurs during pelvic surgery. Spontaneous nontraumatic rupture is even more unusual, with only 14 cases reported in the literature. We report an additional case, summarize all of the cases, and discuss the possible causes and treatment of iliac vein rupture and the role of anticoagulants in postoperative management. (J Vasc Surg 1996;24:284-7.)     

Spontaneous rupture of common iliac artery: a case of Ehlers-Danlos syndrome and review of the literature

Authors report an uncommon case of spontaneous rupture of common iliac artery in a man 43 years old with Ehlers-Danlos syndrome. The clinical presentation was devious in the beginning and catastrophic after few hours with a haemo-peritoneum and haemorragic shock. The Ehlers-Danlos syndrome is a rare affection of the connective tissue with an incidence of 1/5000, representing one of the most common disorders of the connective tissue. This disease is characterized by the fragility of arteries, intestine and uterus. Its presentation is often catastrophic, with rupture of a big artery, rupture of uterus during pregnancy or bowel perforation. The mean age of death in subjects with Ehlers-Danlos syndrome is 45 years. This syndrome is inherited in most cases in an autosomal dominant manner; 50% of the cases are due to new mutations. A minority of cases, due to deficit of tenascina X, is inherited in an autosomal recessive manner.     

Type B aortic dissection with rupture of the left common iliac artery: a case report

Type B aortic dissection involves the appearance of a false lumen distal to the left subclavian artery and extending distally into the descending thoracic aorta and into the abdominal aorta. Complications of the dissection include rupture of the thoracic aorta, leg ischemia, visceral ischemia, and renal failure. A 37-year-old man presented with complaints of sudden onset of chest pain, left leg pain, and numbness. Examination revealed no femoral, popliteal, or distal pulses with decreased sensory and motor function on the left lower extremity. A CT scan revealed an aortic dissection at the proximal descending aorta extending into the iliac arteries with a left retroperitoneal hematoma at the iliac bifurcation. An MRI confirmed the dissection distal to the left subclavian artery into the iliac artery with a distal occlusion. Exploration revealed rupture of the left iliac artery dissection with arterial occlusion and a contained hematoma. The common iliac artery was ligated and an 8-mm Dacron bypass graft from the right common femoral artery to the left femoral artery was performed. Type B aortic dissection can present as rupture of the common iliac artery. Revascularization of the extremity with a femoral-femoral crossover graft is the recommended procedure in the absence of visceral ischemia. The surgeon should have a keen suspicion of this rare complication and its management.     

Spontaneous rupture of adrenal pheochromocytoma: a case report

A case of right adrenal pheochromocytoma was described which presented as an acute abdominal emergency and resulted in shock due to spontaneous rupture into the retroperitoneum. Spontaneous remission of clinical symptoms followed and the tumor was safely resected later. Scintigraphic imaging using 131I-metaiodobenzylguanidine clearly demonstrated the tumor when endocrinological examinations were within normal ranges.     

Spontaneous rupture of splenic hamartoma: a case report

Splenic hamartomas are rare. The authors report a case of spontaneously ruptured splenic hamartoma in a 5-month-old boy. This rupture led to the death of the child. If abdominal pain is present and a mass is palpated, the splenic hamartoma should be managed surgically in an expeditious manner. There have been only two known previous reports of spontaneous rupture of splenic hamartoma in adults, but none in children.