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Complete and Partial Resuscitative Endovascular Balloon Occlusion of the Aorta for Hemorrhagic Shock
Published on: May 19, 2022
Life-threatening hemorrhage from the corona mortis treated with balloon-assisted coiling technique
Xinjian Xu1, Fei Teng2, Jingjing Li1
1Department of Radiology, Affiliated Taizhou Hospital of Wenzhou Medical University, Taizhou, Zhejiang Province 317000, China.
Insights
Elderly patients with pubic ramus fractures can experience severe bleeding from the corona mortis. Prompt angiography and embolization of this vascular structure can effectively manage the bleeding, leading to satisfactory recovery.
Area of Science:
- Trauma surgery
- Vascular surgery
- Geriatric orthopedics
Background:
- Pubic ramus fractures are common in the elderly, often uncomplicated.
- These fractures are anatomically close to the corona mortis, a significant vascular anastomosis.
- The corona mortis connects the internal and external iliac vessels, posing a bleeding risk.
Observation:
- An 88-year-old male presented with a right superior pubic ramus fracture.
- The patient developed severe hemodynamic instability.
- Emergent angiography revealed injury to the corona mortis.
Findings:
- The pubic ramus fracture caused significant bleeding from the corona mortis artery.
- Super-selective embolization using a balloon-assisted coiling technique successfully occluded the bleeding vessel.
- The patient's hemodynamic status stabilized post-embolization.
Implications:
- This case highlights the potential for severe vascular injury in seemingly simple pubic ramus fractures.
- Early recognition and endovascular intervention are crucial for managing associated hemorrhage.
- Embolization provides an effective treatment for corona mortis bleeding, improving patient outcomes.
Abstract:
Isolated pubic ramus fractures are common and generally uncomplicated injuries in the elderly. However, pubic ramus fractures are closely related to important vascular structures. The corona mortis, located in the retropubis, has an important anastomotic value, as it serves as a communication between the internal and external iliac vessels. The following case report describes an 88-year-old male who was diagnosed with a right superior pubic ramus fracture, which led to a severe picture of hemodynamic instability. Emergent angiography demonstrated injury of the corona mortis. After super-selective embolization of the corona mortis artery with a balloon-assisted coiling technique, the patient progressed satisfactorily and was discharged after 7days.
