Delayed torrential haemorrhage after firearm injury

Abstract

A 30-year-old man was referred to us after 48 days of gunshot injury to left groin, with torrential bleeding from a pseudoaneurysm of the left external iliac artery. He was successfully managed with a team of specialists involving trauma surgeon, vascular and plastic surgeon, general surgeons and intervention radiologist with the help of critical care specialists. He required judicious debridement, a transverse rectus abdominis musculocutaneous flap, stenting of the external iliac artery, repair of the external iliac vein and ligation of the bilateral internal iliac artery. He had prolonged intensive care unit stay with open abdomen requiring specialised care. Errors in regular assessment of patient by clinical and radiological examination along with failure in early adequate debridement were responsible for trauma suffered by him. Though it is a rare injury, these devastating complications can occur after any gunshot injury and proper management guidelines must be established. Copyright 2014 BMJ Publishing Group. All rights reserved.