Iliac Arteriovenous Fistula and Pseudoaneurysm Secondary to Gunshot Trauma

TL;DR

A 24-year-old man with gunshot wounds developed a rare iliac arteriovenous fistula and pseudoaneurysm, requiring urgent surgical intervention and highlighting the importance of accurate imaging.

Contribution

This case emphasizes the diagnostic value of biphasic CTA in identifying AVF and guiding treatment in penetrating abdominal trauma.

Findings

Biphasic CTA confirmed an arteriovenous fistula between the right external iliac artery and vein.

Surgical repair of the fistula and associated intra-abdominal injuries led to patient recovery.

Persistent serous discharge was managed during follow-up after surgery.

Abstract

Abdominal arteriovenous fistula [AVF] is a rare but serious complication of penetrating trauma, often associated with high morbidity and mortality. This report presents the case of a 24-year-old male who sustained multiple gunshot wounds, leading to the formation of an ilio-iliac AVF and a pseudoaneurysm. The patient arrived at the emergency department hemodynamically unstable, with bullet wounds to the forearm, thigh, and lumbosacral region. Initial non-arterial phase CT revealed a pseudoaneurysm anterior to the right external iliac vessels and a surrounding hematoma, raising suspicion for AVF. A second biphasic CTA confirmed an AVF connection between the right external iliac artery and external iliac vein, as well as the arterialization of the vein. Additionally, fat stranding and bowel wall thickening suggested potential hollow viscus injury. Due to the patient’s unstable condition and possible intra-abdominal injuries, an open laparotomy was performed. A stent was placed in the right external iliac artery, the vein was primarily repaired, and serosal injuries to the duodenum and cecum were surgically addressed. The patient recovered gradually, although a persistent serous discharge was noted and managed in follow-up. This case highlights the importance of considering AVF in penetrating abdominal trauma and the critical role of biphasic CTA in diagnosis and surgical planning.

Figures