背景:Leriche综合征是由动脉粥样硬化引起的,通常以间歇性跛行和下肢麻木和寒冷等症状为特征。它的确切患病率和发病率是未知的,因为它是一种罕见的疾病。我们报告了一例在创伤全扫描计算机断层扫描(CT)上偶然诊断出的Leriche综合征。
方法:一名61岁的亚洲男性驾驶乘用车,与需要紧急呼叫的自卸卡车正面碰撞。病人被用医生的直升机送到我们医院。体格检查显示以下生命体征:呼吸频率,每分钟23次呼吸;在10升给药面罩下,SpO2为98%;脉搏率,每分钟133次;血压,142/128mmHg;创伤超声聚焦评估,积极;格拉斯哥昏迷量表评估,E3V5M6;和体温,35.9℃创伤全扫描CT显示双侧下颌骨骨折,双侧多发性肋骨骨折,双侧气胸,胸骨骨折,胸椎周围血肿,小肠穿孔,肠系膜损伤,右锁骨骨折,右踝关节清创伤,和从腹主动脉分叉上方到双侧髂总动脉的血栓闭塞。尽管需要将血栓性闭塞与创伤性主动脉损伤区分开来,侧支血管的存在导致了Leriche综合征的诊断,并进行保守治疗。小肠损伤需要进行损伤控制手术。从入学的第二天开始,患者接受持续静脉肝素和前列腺素制剂治疗.然而,右下肢血流受损和再灌注损伤进展。在入学的第五天,进行了右大腿截肢。从入院的第三天开始,患者需要肾脏替代疗法2周。
结论:在这种情况下,Leriche综合征最初选择了保守治疗.然而,创伤急性期的复杂因素导致出血性坏死的发展,需要截肢下肢。我们的发现表明,在考虑治疗指征和创伤选择时,需要仔细考虑影响Leriche综合征患者的独特因素。
BACKGROUND: Leriche syndrome is caused by atherosclerosis and is often characterized by symptoms such as intermittent claudication and numbness and coldness of the lower limbs. Its exact prevalence and incidence are unknown because it is a rare disease. We report a
case of Leriche syndrome diagnosed incidentally on trauma pan-scan computed tomography (CT).
METHODS: A 61-year-old Asian male was driving a passenger car and had a head-on collision with a dump truck that required an emergency call. The patient was transported to our hospital in a doctor\'s helicopter. Physical examination revealed the following vital signs: respiratory rate, 23 breaths per min; SpO2, 98% under a 10-L administration mask; pulse rate, 133 beats per min; blood pressure, 142/128 mmHg; Focused Assessment with Sonography for Trauma, positive; Glasgow Coma Scale assessment, E3V5M6; and body temperature, 35.9 °C. Trauma pan-scan CT showed bilateral mandibular fractures, bilateral multiple rib fractures, bilateral pneumothorax, sternal fractures, hematoma around thoracic spine, small bowel perforation, mesenteric injury, right clavicle fracture, right ankle debridement injury, and thrombotic occlusion from just above the abdominal aortic bifurcation to the bilateral common iliac arteries. Although thrombotic occlusion needed to be differentiated from traumatic aortic injury, the presence of collateral blood vessels led to the diagnosis of Leriche syndrome, and conservative treatment was performed. Damage control surgery was required for the small bowel injuries. From the second day of admission, the patient was treated with continuous intravenous heparin and prostaglandin preparations. However, impaired blood flow and reperfusion injury in the right lower extremity progressed. On the fifth day of admission, right thigh amputation was performed. The patient required renal replacement therapy for 2 weeks starting from the third day of admission.
CONCLUSIONS: In this
case, conservative therapy was initially chosen for Leriche syndrome. However, the complex factors in the acute phase of trauma led to development of hemorrhagic necrosis, requiring amputation of the lower extremity. Our findings indicate the need to carefully consider the unique factors affecting Leriche syndrome patients when considering treatment indications and choices for trauma.