Multiple trauma including pelvic fracture with multiple arterial embolization: an autopsy case report

Area of Science:

• Trauma Surgery
• Interventional Radiology
• Critical Care Medicine

Background:

• Pelvic fractures from high-energy trauma are associated with high mortality, particularly in elderly men.
• Risk factors for mortality include severe polytrauma, major hemorrhage, and red blood cell transfusion.
• This report details a rare case of multiple arterial embolization secondary to pelvic fracture.

Observation:

• An 83-year-old male sustained multiple traumas, including pelvic and acetabular fractures, after a car accident.
• The patient experienced significant hemorrhage requiring massive transfusion and embolization of the right superior gluteal artery and left adrenal artery.
• Post-embolization, he developed right lower extremity ischemia, necessitating amputation, followed by acute kidney injury and multi-organ failure.

Findings:

• The patient's death was attributed to persistent rhabdomyolysis and severe hypotension from iliopsoas muscle necrosis and peritonitis from digestive tract necrosis.
• Consumption coagulopathy associated with polytrauma likely precipitated the multiple arterial embolizations.
• Necropsy confirmed extensive muscle and digestive tract necrosis.

Implications:

• This case underscores the potential for catastrophic complications, including multiple arterial embolization, in elderly patients with high-energy pelvic fractures.
• Aggressive management of coagulopathy and early recognition of ischemic complications are crucial.
• Understanding rare complications is vital for improving outcomes in severe trauma patients.