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Successful treatment of posttraumatic phlegmasia cerulea dolens by reconstructing the external iliac vein: a case report.
J Med Case Rep. 2014 May 14; 8:149.JM

Abstract

INTRODUCTION

Phlegmasia cerulea dolens is a rare condition caused by complete venous occlusion leading to impaired arterial flow. To prevent progression to limb gangrene, prompt diagnosis and treatment initiation are paramount. Here we report a rare case of posttraumatic phlegmasia cerulea dolens after ligation of the iliac vein to save the patient's life, with successful treatment by reconstructing the external iliac vein. This is the first report of posttraumatic phlegmasia cerulea dolens induced by iliac vein ligation.

CASE PRESENTATION

A 49-year-old Chinese man was admitted to a local hospital for severe knife trauma with massive intraperitoneal bleeding. During exploratory laparotomy, he was diagnosed with traumatic rupture of his left external iliac vein without injury to the iliac artery. The proximal and distal parts of his injured external iliac vein were ligated to control the bleeding and rescue him, but his left leg quickly became severe swollen, cyanotic and pulseless. He was diagnosed with posttraumatic phlegmasia cerulea dolens after being transferred to our university hospital. After a retrievable filter was placed in his inferior vena cava via his right femoral vein, he underwent reopening of his abdomen followed by successful surgical reconstruction of his left iliac vein. He was treated with anticoagulation therapy postoperatively and his signs and symptoms improved markedly. He was discharged in a stable condition, with nearly full resolution of symptoms, 35 days after the operation.

CONCLUSIONS

Our case demonstrates that ligation of an injured iliac vein may induce phlegmasia cerulea dolens in a posttraumatic scenario; prompt reconstruction of the iliac vein to restore the venous drainage is an effective treatment for phlegmasia cerulea dolens with impending gangrene.

Authors+Show Affiliations

Division of Vascular and Thyroid Surgery, Department of Surgery, The First Affiliated Hospital, China Medical University, Shenyang 110001, China. hu_haidi@hotmail.com.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Case Reports
Journal Article

Language

eng

PubMed ID

24885801

Citation

Hu, Haidi, et al. "Successful Treatment of Posttraumatic Phlegmasia Cerulea Dolens By Reconstructing the External Iliac Vein: a Case Report." Journal of Medical Case Reports, vol. 8, 2014, p. 149.
Hu H, Cai Y, Wang C, et al. Successful treatment of posttraumatic phlegmasia cerulea dolens by reconstructing the external iliac vein: a case report. J Med Case Rep. 2014;8:149.
Hu, H., Cai, Y., Wang, C., Yang, C., Duan, Z., Zhang, J., & Xin, S. (2014). Successful treatment of posttraumatic phlegmasia cerulea dolens by reconstructing the external iliac vein: a case report. Journal of Medical Case Reports, 8, 149. https://doi.org/10.1186/1752-1947-8-149
Hu H, et al. Successful Treatment of Posttraumatic Phlegmasia Cerulea Dolens By Reconstructing the External Iliac Vein: a Case Report. J Med Case Rep. 2014 May 14;8:149. PubMed PMID: 24885801.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Successful treatment of posttraumatic phlegmasia cerulea dolens by reconstructing the external iliac vein: a case report. AU - Hu,Haidi, AU - Cai,Yongchang, AU - Wang,Chuanjiang, AU - Yang,Chunqing, AU - Duan,Zhiquan, AU - Zhang,Jian, AU - Xin,Shijie, Y1 - 2014/05/14/ PY - 2013/08/16/received PY - 2014/03/10/accepted PY - 2014/6/3/entrez PY - 2014/6/3/pubmed PY - 2015/1/18/medline SP - 149 EP - 149 JF - Journal of medical case reports JO - J Med Case Rep VL - 8 N2 - INTRODUCTION: Phlegmasia cerulea dolens is a rare condition caused by complete venous occlusion leading to impaired arterial flow. To prevent progression to limb gangrene, prompt diagnosis and treatment initiation are paramount. Here we report a rare case of posttraumatic phlegmasia cerulea dolens after ligation of the iliac vein to save the patient's life, with successful treatment by reconstructing the external iliac vein. This is the first report of posttraumatic phlegmasia cerulea dolens induced by iliac vein ligation. CASE PRESENTATION: A 49-year-old Chinese man was admitted to a local hospital for severe knife trauma with massive intraperitoneal bleeding. During exploratory laparotomy, he was diagnosed with traumatic rupture of his left external iliac vein without injury to the iliac artery. The proximal and distal parts of his injured external iliac vein were ligated to control the bleeding and rescue him, but his left leg quickly became severe swollen, cyanotic and pulseless. He was diagnosed with posttraumatic phlegmasia cerulea dolens after being transferred to our university hospital. After a retrievable filter was placed in his inferior vena cava via his right femoral vein, he underwent reopening of his abdomen followed by successful surgical reconstruction of his left iliac vein. He was treated with anticoagulation therapy postoperatively and his signs and symptoms improved markedly. He was discharged in a stable condition, with nearly full resolution of symptoms, 35 days after the operation. CONCLUSIONS: Our case demonstrates that ligation of an injured iliac vein may induce phlegmasia cerulea dolens in a posttraumatic scenario; prompt reconstruction of the iliac vein to restore the venous drainage is an effective treatment for phlegmasia cerulea dolens with impending gangrene. SN - 1752-1947 UR - https://www.unboundmedicine.com/medline/citation/24885801/Successful_treatment_of_posttraumatic_phlegmasia_cerulea_dolens_by_reconstructing_the_external_iliac_vein:_a_case_report_ L2 - https://jmedicalcasereports.biomedcentral.com/articles/10.1186/1752-1947-8-149 DB - PRIME DP - Unbound Medicine ER -