[Wounding of an iliac artery during celioscopy].
Vascular accidents during celioscopy are rare but potentially serious. Arterial injuries usually involve the aortic bifurcation and are generally recognized and treated as emergencies. In the present case, a transfixing wound of the right common iliac artery provoked by a trocar during gynecological celioscopy in a 36 year old woman was diagnosed secondarily, the posterior orifice being unrecognized during laparotomy to control hemorrhage. A false iliac artery aneurysm was detected 2 months later when she presented signs of a compressive retroperitoneal hematoma confirmed by arteriography and scan images. The common iliac artery was ligatured through a right retroperitoneal approach with extra-anatomical revascularization by a crossed iliofemoral venous shunt. The postoperative course was uncomplicated apart from a right cruralgia sequela. Immediate circumferential dissection for treatment of aortic bifurcation injuries is recommended, to avoid missing a transfixing wound, and to allow direct restoration usually by simple suture. In contrast, secondary treatment is complex, raises problems of arterial reconstruction, and cannot always prevent functional sequelae.
Gayral
M
M
Service de chirurgie vasculaire, Hôpital Edouard Herriot, Lyon.
Reveilleau
P
P
Duchemin
J F
JF
Nassredine
H
H
Chevalier
J M
JM
D000328:Adult; D000792:Angiography; D001807:Blood Vessel Prosthesis; D004724:Endoscopy / Q000009:adverse effects*; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007049:Iatrogenic Disease; D007083:Iliac Artery / Q000293:injuries* / Q000503:physiopathology / Q000601:surgery; D011183:Postoperative Complications; D012187:Retroperitoneal Space / Q000000981:diagnostic imaging / Q000503:physiopathology*; D014057:Tomography, X-Ray Computed
Plaie d'une artère iliaque au cours d'une coelioscopie.