We report a 54-year old Caucasian female patient who was involved in a car accident. She was the driver of the car, and was hit by another car on the driver's side. The fellow passenger of the car was seriously injured and was treated in hospital for traumatic brain injury. Both of the passengers were wearing their seatbelts correctly, and the female patient did not lose consciousness.
At the first hospital, where the female patient underwent pelvic X-ray, an acetabular fracture on the left side was detected. The patient was then transported to the second hospital, where a CT scan of the pelvis was performed. This revealed a multiple-fragment fracture of the left acetabulum. The patient was later given a tetanus vaccination and a trans-urethral catheter was put in place. At this time, urine did not show any signs of macroscopic hematuria.
Later, following communication via telephone, the patient was brought to our institution, a level 1 trauma-center, by helicopter. Because of the nature of the accident, with a high-energy trauma, complete polytrauma management was performed. During the body check, under pain in the left part of the pelvis, a moderate tension of the lower parts of the abdomen was observed. The ultrasound did not reveal any free abdominal fluid. Blood count showed normal values. In addition to the multiple-fragment fracture of the left acetabulum, the CT scan revealed an aneurysm of the infra-renal aorta with a dissection from the height of the second lumbar vertebral body to the iliac artery (Figures 1 and 2).
Because of the aneurysm, the patient required operative vascular surgical intervention on the day of admission. During this operation, a vascular substitute of the aorta with a 14/7 mm Dacron-Y-prosthesis was used to reconnect the superior mesenteric artery.
Nine days postoperatively, the open reduction and internal fixation of the acetabular fracture was performed without any incidence.
Nineteen days post trauma, the patient was discharged from the hospital in good general condition. She did not show any signs of vascular deficits of the lower limbs or in the abdominal organs.