RESUMEN

The medial circumflex femoral artery contributes to the blood supply of the adductor muscles, hip joint, and femoral head. Its variations are common and important in the surgical field, as its damage can cause femoral head necrosis. Most commonly, the variations include different origin patterns from the femoral artery or its branches. Here we report a very rare variation of suprainguinal origin of the medial circumflex femoral artery from the external iliac artery in the common trunk with the inferior epigastric artery. Because of the rarity, such an arterial variation not commonly suspected during open or laparoscopic surgery may result in devastating consequences.

RESUMEN

Anatomic variations of the iliofemoral arterial system are rare. We describe the pattern of a complete arterial loop (360 degree) of the external iliac artery detected incidentally in a lady who presented with abdominal pain.

Asunto(s)

Variación Anatómica , Arteria Ilíaca , Humanos , Arteria Ilíaca/anomalías , Arteria Ilíaca/diagnóstico por imagen , Femenino , Hallazgos Incidentales , Dolor Abdominal/etiología , Persona de Mediana Edad , Angiografía por Tomografía Computarizada

RESUMEN

INTRODUCTION: Iliac artery aneurysms are rare, with isolated iliac artery aneurysms responsible for only 2 % of all aneurysmal diseases. External iliac artery (EIA) aneurysms are extremely rare, and the exact cause is unknown. In this case, we report a giant aneurysm without any risk factor presented with rupture and managed by open repair. PRESENTATION OF CASE: An 85-year-old man presented to the emergency department with sudden onset right lower quadrant abdominal pain and vague right lower limb pain. After a complete physical examination, an abdominopelvic CT scan revealed an 80 mm EIA aneurysm containing thrombosis and active leakage. The patient underwent open repair of an aneurysm using a graft between the Aorta and EIA. The surgery was uneventful. Later in the ICU, the patient experienced a cardiac arrest and unfortunately could not recover from it. DISCUSSION: In this case, a patient with a relatively large aneurysm presented with abdominal pain and lower limb discomfort. Although endovascular surgery is recommended for the repair of iliac aneurysms, open repair is common for ruptured aneurysms. Endovascular repair is less invasive but may lead to contrast-induced renal dysfunction. Open repair may induce complications such as sexual dysfunctions, graft infection, and pelvic ischemic conditions. CONCLUSION: EIA aneurysms are exceedingly rare. They may present with a Rupture that puts the patient in critical condition, such as in this case. Due to the hemodynamic instability, open repair is considered one of the main approaches for repairing the aneurysm.

RESUMEN

PURPOSE: Measure out of the standard interval in the aorta diameter is a clue for aortic aneurysm or hypoplasia. Pediatric studies focusing specifically on the normal diameter of the abdominal aorta (AA) were limited in the literature. Therefore, the main goal of this work was to determine changes in the effective diameter of AA in healthy children aged 1-18 years for diagnosis of vascular diseases. METHODS: This retrospective work focused on abdominopelvic computed tomography views of 180 children (sex: 90 males / 90 females, average age: 9.50 ± 5.20 years) without any abdominopelvic disease to measure diameters of AA, common iliac artery (CIA), external iliac artery (EIA), and first lumbar vertebra (L1). RESULTS: Vessel and vertebra diameters increased in pediatric subjects between 1 and 18 years (p < 0.001). Considering pediatric age periods, vessel diameters increased steadily, but L1 diameter showed an irregular growth pattern between age periods. All parameters were greater in males than females (p < 0.05), except from effective diameters of AA over the coeliac trunk (p = 0.084) and over the renal artery (p = 0.051). The ratios of diameters of vessels to L1 increased depending on ages between 1 and 18 years. Considering pediatric age periods, the ratios increased from infancy period to postpubescent period in irregular pattern; however, the ratios for right and left CIA, and AA over the aortic bifurcation did not alter after late childhood period. All ratios for males were similar to females (p > 0.05). CONCLUSION: Our age-specific ratios may be beneficial for surgeons and radiologists for the diagnosis of vascular disorders such as aortic aneurysm.

Asunto(s)

Aorta Abdominal , Humanos , Niño , Masculino , Femenino , Aorta Abdominal/diagnóstico por imagen , Aorta Abdominal/anatomía & histología , Preescolar , Adolescente , Estudios Retrospectivos , Lactante , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/anatomía & histología , Valores de Referencia , Tomografía Computarizada por Rayos X , Vértebras Lumbares/diagnóstico por imagen , Vértebras Lumbares/irrigación sanguínea

RESUMEN

BACKGROUND: External iliac artery endofibrosis (EIAE) is an uncommon pathology, predominantly occurring in cyclists, caused by thickening of the external iliac artery intima. Symptoms are exercise-dependent and typically consist of pain, muscle cramps and loss of strength in the affected limb at (sub)maximal effort. As other musculo-skeletal as well as conditional problems might cause similar complaints diagnosis is not always easy or straightforward. CASE SUMMARY AND DISCUSSION: We reviewed four cases of (semi-)professional cyclists referred to our department in 2021 because of suspicion of EIAE. In all symptoms only occurred at (sub)maximal effort. All had lowering of ABI on the affected side at a dynamic stress test on the bike. Imaging using CTA, MRA or dynamic angiogram was abnormal in all patients, showing signs suspicious for endofibrosis but of different kind and at different locations. Open surgical repair was performed in all cases by a procedure tailored to the type of lesion. Two patients were treated by a saphenous vein patch angioplasty, in one patient a shortening of the vessel and end-to-end anastomosis was performed and in the fourth patient a spiral saphenous vein graft bypass was placed. Postoperative course was uneventful and exercise was resumed after four weeks in all patients. CONCLUSION: Correct diagnosis is essential in the treatment of EIAE. A complete and multidisciplinary pathway should be followed to distinguish vascular from non-vascular causes. Correct lesion localization is crucial and besides CTA or MRA, more sophisticated techniques such as dynamic angiography or intravascular ultrasound might be needed.

Asunto(s)

Ciclismo , Fibrosis , Arteria Ilíaca , Humanos , Arteria Ilíaca/diagnóstico por imagen , Masculino , Ciclismo/lesiones , Persona de Mediana Edad , Adulto , Femenino

RESUMEN

PURPOSE: The aim of the study was to determine the flexion point's location of the ilio-femoral arterial axis and its angulation. MATERIALS AND METHODS: Thirty-seven dynamic digital subtraction angiographies were analyzed and were included in the current study. Different lengths were measured, based on specific anatomical landmarks: the origin of the external iliac artery, the inguinal ligament and the bifurcation of the femoral artery. These lengths were measured in extension and during flexion of the hip in order to determine the flexion point of the artery. RESULTS: In extension, some physiological angulations of the external iliac artery were measured. During flexion of the hip joint, the distance from the kink point to the bifurcation of the common iliac artery was respectively 82 ± 21 mm (range 48-116) on the right side and 95 ± 20 mm (range 59-132) on the left side. The distance from the kink point to the inguinal ligament was respectively 38 ± 40 mm (range 12-138) on the right side and 26 ± 23 mm (range 8-136) on the left side. The distance from the kink point to the bifurcation of the femoral artery was respectively 45 ± 29 mm (range 15-107) on the right side and 27 ± 12 mm (range 10-66) on the left side. During flexion, the angulation of the flexion point of the ilio-femoral axis was 114 ± 18° (range 81-136°). CONCLUSIONS: The flexion point was located cranially to the inguinal ligament and below the departure of the external iliac artery.

Asunto(s)

Angiografía de Substracción Digital , Arteria Femoral , Articulación de la Cadera , Arteria Ilíaca , Humanos , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/anatomía & histología , Masculino , Arteria Femoral/diagnóstico por imagen , Arteria Femoral/anatomía & histología , Femenino , Persona de Mediana Edad , Adulto , Articulación de la Cadera/diagnóstico por imagen , Anciano , Puntos Anatómicos de Referencia , Rango del Movimiento Articular/fisiología

RESUMEN

BACKGROUND: External iliac artery endofibrosis (EIAE) is a rare vascular disease which has been traditionally seen in avid cyclists. The conventional approach has been surgery, although no high-quality evidence suggests superiority of surgery over percutaneous endovascular intervention. There are limited data on the efficacy of stenting in EIAE. METHODS: Over a 14-year period, we treated 10 patients (13 limbs) with EIAE with stents. These patients had declined surgery. The mean follow up was 8.4 ± 3.3 years. There were eight women. Five patients were competitive runners, three were cyclists, and two were triathletes. The mean age was 40.7 ± 2.9 years and body mass index was 19.46 ± 1.6. Intravascular ultrasound (IVUS) was used in eight limbs. RESULTS: Procedural success was achieved in all. The recurrence of symptoms occurred in three patients at a mean of 9.3 ± 2.1 months postindex intervention. The other seven patients remained symptom free. IVUS revealed a pathognomonic finding which we termed 'perfect circle appearance'. It results from symmetric or asymmetric hypertrophy of one or more layers of the arterial wall leading to negative remodeling, which creates a distinct echo dense structure contrasting itself from the luminal blood's echoluscent appearance. It is identical to IVUS images of diffuse venous stenosis with important implications in the treatment technique. CONCLUSIONS: We conclude that stenting in EIAE is safe and effective with a good long-term outcome. It can be an alternative to surgery, particularly in those patients who refuse a surgical approach. The IVUS image is pathognomonic and 'sine qua non' of EIAE.

Asunto(s)

Fibrosis , Arteria Ilíaca , Stents , Ultrasonografía Intervencional , Humanos , Femenino , Masculino , Arteria Ilíaca/diagnóstico por imagen , Arteria Ilíaca/cirugía , Adulto , Factores de Tiempo , Resultado del Tratamiento , Persona de Mediana Edad , Estudios Retrospectivos , Recurrencia , Grado de Desobstrucción Vascular , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Enfermedad Arterial Periférica/terapia , Enfermedad Arterial Periférica/diagnóstico por imagen

RESUMEN

Adverse iliofemoral anatomy can preclude complex endovascular aortic aneurysm repair. This study aims to describe the "up-and-over" staged endoconduit technique to improve access and avoid vascular injury before complex endovascular aneurysm repair. A staged procedure for complex endovascular aortic aneurysm repair is performed using an endoconduit (W.L. Gore & Associates). After obtaining contralateral femoral access, the extension of iliofemoral disease is assessed using angiography. The endoconduit is advanced "up and over" the aortic bifurcation and delivered percutaneously into the common femoral artery to treat a diseased access site and maintain intact the ipsilateral femoral access for future stent graft deployment. Internal iliac artery patency is maintained when feasible. During complex aneurysm repair, the endoconduit is accessed directly under ultrasound guidance using sequential dilation to avoid vascular injury. PerClose sutures (Abbott Vascular) are used to close the endoconduit femoral access site. This study found that staged "up and over" endoconduit creation is a useful technique before complex endovascular aneurysm repair in patients with adverse iliofemoral anatomy. Avoiding accessing the main femoral access site during the first stage prevents vascular or access site injuries and allows for both iliac and femoral disease to be addressed.

RESUMEN

OBJECTIVE: Adverse iliofemoral anatomy may preclude complex endovascular aortic aneurysm repair (EVAR). In our practice, staged iliofemoral endoconduits (ECs) are planned prior to complex EVAR to improve vascular access and decrease operative time while allowing the stented vessel to heal. This study describes the long-term results of iliofemoral ECs prior to complex EVAR. METHODS: Between 2012 and 2023, 59 patients (44% male; median age, 75 ± 6 years) underwent ECs before complex EVAR using self-expanding covered stents (Viabahn). For common femoral artery (CFA) disease, ECs were delivered percutaneously from contralateral femoral access and extended into the CFA to preserve the future access site for stent graft delivery. Internal iliac artery patency was maintained when feasible. During complex EVAR, the EC extended into the CFA was directly accessed and sequentially dilated until it could accommodate the endograft. Technical success was defined as successful access, closure, and delivery of the endograft during complex EVAR. Endpoints were vascular injury or EC disruption, secondary interventions, and EC patency. RESULTS: Unilateral EC was performed in 45 patients (76%). ECs were extended into the CFA in 21 patients (35%). Median diameters of the native common iliac, external iliac, and CFA were 7 mm (interquartile range [IQR], 6-8 mm), 6 mm (IQR, 5-7 mm), and 6 mm (IQR, 6-7 mm), respectively. Internal iliac artery was inadvertently excluded in 10 patients (17%). Six patients (10%) had an intraoperative vascular injury during the EC procedure, and six patients (10%) had EC disruption during complex EVAR, including five EC collapses requiring re-stenting and one EC fracture requiring open cut-down and reconstruction with patch angioplasty. In 23 patients (39%), 22 Fr OD devices were used; 20 Fr were used in 22 patients (37%), and 18 Fr in 14 patients (24%). Technical success for accessing EC was 89%. There was no difference in major adverse events at 30 days between the iliac ECs and iliofemoral ECs. Primary patency by Kaplan-Meier estimates at 1, 3, and 5 years were 97.5%, 89%, and 82%, respectively. There was no difference in primary patency between iliac and iliofemoral ECs. Six secondary interventions (10%) were required. The mean follow-up was 34 ± 27 months; no limb loss or amputations occurred during the follow-up. CONCLUSIONS: ECs improve vascular access, and their use prior to complex EVAR is associated with low rates of vascular injury, high technical success, and optimal long-term patency. Complex EVAR procedures can be performed percutaneously by accessing the EC directly under ultrasound guidance and using sequential dilation to avoid EC disruption.

Asunto(s)

Implantación de Prótesis Vascular , Prótesis Vascular , Procedimientos Endovasculares , Arteria Femoral , Arteria Ilíaca , Stents , Grado de Desobstrucción Vascular , Humanos , Masculino , Anciano , Femenino , Procedimientos Endovasculares/instrumentación , Procedimientos Endovasculares/efectos adversos , Resultado del Tratamiento , Factores de Tiempo , Implantación de Prótesis Vascular/instrumentación , Implantación de Prótesis Vascular/efectos adversos , Anciano de 80 o más Años , Arteria Femoral/cirugía , Arteria Femoral/fisiopatología , Arteria Femoral/diagnóstico por imagen , Estudios Retrospectivos , Arteria Ilíaca/cirugía , Arteria Ilíaca/fisiopatología , Arteria Ilíaca/diagnóstico por imagen , Diseño de Prótesis , Aneurisma de la Aorta Abdominal/cirugía , Aneurisma de la Aorta Abdominal/diagnóstico por imagen , Aneurisma de la Aorta Abdominal/fisiopatología , Factores de Riesgo , Complicaciones Posoperatorias/etiología

RESUMEN

In recent years, endovascular treatment has become the first-line revascularisation method for aortoiliac artery occlusive disease. Rarely, aortoiliac artery occlusive disease may be associated with stenosis of the external iliac artery (EIA) that suggested pseudo-stenosis. We describe a case of aortoiliac artery occlusive disease with EIA stenosis without calcification or atheroma. Stent grafts were inserted from the abdominal aorta to the bilateral common iliac arteries. Pre-operative computed tomography and intravascular ultrasound findings confirmed the absence of calcification or atheroma in both EIA, suggesting that the EIA had developed pseudo-stenosis. Following endovascular treatment, the EIA diameter recovered only with balloon dilation after inflow improvement. Consideration is necessary when placing an easy stent graft in the narrow EIA during endovascular treatment for aortoiliac artery occlusive disease with EIA stenosis to avoid a potential stent graft diameter mismatch.

RESUMEN

A 67-year-old man suffered sudden chest pain. Computed tomography with contrast medium revealed dissection from the ascending aorta to the bilateral iliac arteries and hematoma around the left external iliac artery. Type A acute aortic dissection complicated with rupture of the left external iliac artery was diagnosed. Urgent endovascular repair (stent-graft implantation) was first performed for the arterial rupture more critical than the aortic dissection. On the next day after satisfactory hemostasis and hemodynamical stabilization, semi-urgent ascending aortic replacement was achieved, and the patient survived. Acute aortic dissection complicated with rupture of the aortic branch was extremely rare, and only 5 cases have been reported in the English literature.

RESUMEN

A 28-day-old Holstein calf with astasia (i.e., right hind limb flaccid paralysis) was referred to Large Animal Veterinary Educational Center. Thoracic radiographs showed an alveolar pattern and air bronchograms indicating pneumonia, whereas skeletal radiography showed muscle atrophy of the right hind limb but no abnormalities in the coxofemoral and stifle joints. Contrast-enhanced computed tomography revealed the pulmonary abscess in the right cranial pulmonary lobe and a thrombus (5 × 5 × 20 mm) in the right external iliac artery distal to the bifurcation of the abdominal aorta. These findings were confirmed via pathological examination. Streptococcus bovis/equinus complex colonies were isolated from the thrombus and pulmonary abscess. Thus, the pulmonary abscess was considered the infectious source of the thromboembolism in the right external iliac artery. Arterial thromboembolism should be included in the differential diagnoses in calves with astasia but without radiographic skeletal abnormalities.

Asunto(s)

Enfermedades de los Bovinos , Absceso Pulmonar , Tromboembolia , Trombosis , Animales , Bovinos , Absceso Pulmonar/veterinaria , Trombosis/diagnóstico , Trombosis/veterinaria , Tomografía Computarizada por Rayos X/veterinaria , Aorta Abdominal , Tromboembolia/diagnóstico por imagen , Tromboembolia/veterinaria , Enfermedades de los Bovinos/diagnóstico por imagen

RESUMEN

External iliac agenesis is an uncommon congenital issue characterized by the absence or incomplete development of the external iliac artery, a significant blood vessel supplying the lower limbs, potentially causing symptoms like pain, weakness, ischemia, and numbness. We are currently discussing a case of a 23-year-old woman who complained of pain in her left lower limb. A thorough work-up was conducted to rule out ischemia, and during the diagnostic process, a CT scan revealed the complete absence of the right external iliac artery. It can be concluded that this is a rare vascular anomaly that can lead to significant morbidity and mortality. Early diagnosis and prompt management are crucial for preventing complications such as limb ischemia and gangrene.

RESUMEN

Iliac artery endofibrosis (IAE), as the name suggests, involves subintimal fibrosis of the iliac artery. IAE is most commonly associated with competitive athletics, particularly cycling, and remains a rather underappreciated diagnosis in the clinical setting. We present two unique and distinct presentations of IAE in competitive athletes. The first case involves a 38-year-old male cyclist who initially presented with complaints of a bulge at the right groin and acute onset monoplegia and paresthesia associated with exertion of the right lower extremity. This patient was referred to vascular surgery and underwent right common iliac artery and proximal common femoral artery endarterectomy with patch angioplasty and Fogarty embolectomy. Case 2 involves a 50-year-old female triathlete who presented with left lower extremity claudication of a more chronic course, with symptoms beginning approximately four years prior. The pain radiated to her upper thigh and was associated with exertion, restricting her exercise tolerance and return to training. After a diagnosis of IAE was made, she was referred to vascular surgery for a left iliofemoral bypass.

RESUMEN

BACKGROUND: Knowledge of vascular anatomy and its possible variations is essential for performing embolization or revascularization procedures and complex surgery in the pelvis. The obturator artery (OA) is a branch of the anterior division of the internal iliac artery (IIA), and it has the highest frequency of variation among branches of the internal iliac artery. Possible anomalies of the origin of the obturator artery (OA) should be known when performing pelvic and groin surgery, where its control or ligation may be required. The purpose of this systematic review and meta-analysis, based on Sanudo's classification, is to analyze the origin of the obturator artery (OA) and its variants. METHODS: Thirteen articles published between 1952 and 2020 were included. RESULTS: The obturator artery (OA) was present in almost all cases (99.8%): the pooled prevalence estimate for the origin from the IIA axis was 77.7% (95% CI 71.8-83.1%) vs. 22.3% (95% CI 16.9-28.2%) for the origin from EIA axis. In most cases, the obturator artery (OA) originated from the anterior division trunk of the internal iliac artery (IIA) (61.6%). CONCLUSIONS: Performing preoperative radiological examination to determine the pelvic vascular pattern and having the awareness to evaluate possible changes in the obturator artery can reduce the risk of iatrogenic injury and complications.

RESUMEN

Background Many patients undergoing transcatheter aortic valve replacement (TAVR) have peripheral artery disease necessitating surgical access. This study reviews the preoperative risk factors, procedural characteristics, and outcomes in patients undergoing surgical common femoral artery (CFA) and external iliac artery (EIA) access through a retro-inguinal groin incision for TAVR. Methods A single-center TAVR database was retrospectively analyzed for patients undergoing surgical cutdown (January 1, 2016 - December 31, 2020). Access sites were evaluated on preoperative imaging. Data on demographics, imaging, procedural characteristics, and outcomes were collected. The vascular surgeon selected the cutdown site. Results A hundred and thirty TAVR patients had surgical cutdown. The choice of access site was either the common femoral artery (82 patients, 63%) or the iliac artery (48 patients, 37%). There was no difference in age, BMI, or medical risk factors. There was no difference in iliac diameter or circumferential iliac calcium. In the iliac group, there was a smaller mean CFA size and a higher incidence of circumferential CFA calcium. In the femoral group, there was: a lower mean sheath-to-CFA ratio, a trend toward increased unplanned endarterectomy, and a higher incidence of 30-day readmission. There was no difference in adjunct procedure use. Conclusion EIA surgical access had similar complication rates and length of stay with a reduced tendency for unplanned endarterectomy when compared to CFA access. The EIA is a suitable access site for TAVR in select patients.

RESUMEN

Key clinical message: This is the first reported case of a pelvic gunshot wound with a bladder injury masking a coinciding left external iliac artery injury. A high index of suspicion for an acute and traumatic ilio-vesical fistula should be raised in the presence of the following triad: bright red hematuria, bladder distension from clot retention, hemodynamic instability after bladder decompression "Mukendi's triad." Abstract: Iliac artery injury from gunshot wounds is very rare and a lethal injury associated with high mortality rate. Concurrent ballistic external iliac artery and bladder injuries resulting in an acute ilio-vesical shunt or fistula and discovered at the time of presentation are extremely rare.In this report, we present an unprecedented case of multiple pelvic gunshot wounds presented with a distended injured bladder full of clots concealing a left external iliac injury by tamponade effect.

RESUMEN

BACKGROUND: Iliac artery occlusion accompanied by spinal canal stenosis is rare. All reported cases were treated with endovascular stenting for iliac artery occlusion. We report the first case of external iliac artery occlusion accompanied by spinal stenosis, which was successfully treated with conservative treatment. CASE PRESENTATION: A 66-year-old man with lower extremity pain and claudication visited the outpatient spine clinic. He complained of a tingling sensation in the L5 dermatome of the right leg and L4 dermatome of the left leg. Magnetic resonance imaging showed central stenosis in at the L4-5 and L5-S1 levels, and lateral recess stenosis at the L5-S1 level. The patient's symptoms were ambiguous with mixed neurological claudication and vascular claudication. Computed tomography of the lower extremity artery showed complete occlusion in the right external iliac artery. Conservative treatment with clopidogrel and beraprost sodium was performed. After treatment, his symptoms gradually improved. Clopidogrel and beraprost sodium were continued for 4 years. Follow-up computed tomography at 4 years showed recanalization of the right external iliac artery occlusion. CONCLUSIONS: We describe a rare case of external iliac artery occlusion and spinal stenosis. External iliac artery occlusion may be successfully treated only with conservative treatment using medication.

Asunto(s)

Arteriopatías Oclusivas , Estenosis Espinal , Masculino , Humanos , Anciano , Estenosis Espinal/complicaciones , Estenosis Espinal/diagnóstico por imagen , Estenosis Espinal/tratamiento farmacológico , Constricción Patológica/complicaciones , Constricción Patológica/diagnóstico por imagen , Arteria Ilíaca/diagnóstico por imagen , Clopidogrel , Arteriopatías Oclusivas/complicaciones , Arteriopatías Oclusivas/diagnóstico por imagen , Arteriopatías Oclusivas/tratamiento farmacológico , Resultado del Tratamiento

RESUMEN

High-flow priapism is an uncommon condition typically resulting from penile or perineal trauma, due to laceration of cavernosal artery. We present a case of 24-year-old male who presented with post-traumatic painless priapism. Ultrasound showed hematoma with arterio-cavernosal fistula. On CT Angiogram, the cavernosal artery was seen arising from accessory pudendal artery, which arose from inferior epigastric artery (IEA), branch of external iliac artery (EIA). Catheter angiogram of EIA showed fistulous communication at the base of the penis from a branch of IEA. Selective embolisation of the artery was done using 33% glue (n-butyl cyanoacrylate). Post embolisation, no residual filling of the fistula and partial detumescence of penis was noted. Transarterial embolisation is usually preferred as first line of management in high-flow fistulous priapisms.

Asunto(s)

Priapismo , Enfermedades Vasculares , Masculino , Humanos , Adulto Joven , Adulto , Arteria Ilíaca/diagnóstico por imagen , Priapismo/diagnóstico por imagen , Priapismo/etiología , Priapismo/terapia , Resultado del Tratamiento , Arterias , Pene/diagnóstico por imagen

RESUMEN

Gastrointestinal complications following radical cystectomy (RC) are a common occurrence, with small bowel obstruction (SBO) a known complication. Limited cases have been reported of SBO following RC due to internal herniation of the small intestine around the ureter, ileal conduit, obturator nerve and, as a consequence of retroperitoneal lymphadenectomy, even the abdominal vasculature. We present a rare case in which intestinal herniation beneath the external iliac artery (EIA) resulted in a closed-loop SBO with ischaemia and necrosis. Intra-operative transection of the unrecognised EIA occurred, necessitating primary arterial repair. This case highlights the importance of maintaining a high index of suspicion for complex pathology and anatomical variations in patients following RC and other operations involving retroperitoneal lymphadenectomy.