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Delayed rupture of common carotid artery following rugby tackle injury: a case report.

Thakore N, Abbas S, Vanniasingham P - World J Emerg Surg (2008)

Bottom Line: He was promptly intubated and had contrast CT angiography of neck vessels which localized the bleeding spot on posteromedial aspect of his Right CCA.Delayed post traumatic rupture of the CCA is an uncommon yet potentially life threatening condition which can be caused by unusual blunt injury mechanism.A high index of suspicion and low threshold for investigating carotid injuries in the setting of blunt trauma is likely to be beneficial.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Middlemore Hospital, Auckland, New Zealand. nainoor@rediffmail.com.

ABSTRACT

Background: Common Carotid Artery (CCA) is an uncommon site of injury following a blunt trauma, its presentation with spontaneous delayed rupture is even more uncommon and a rugby tackle leading to CCA injury is a rare event. What makes this case unique and very rare is combination of all of the above.

Case presentation: Mr H. presented to the Emergency Department with an expanding neck haematoma and shortness of breath. He was promptly intubated and had contrast CT angiography of neck vessels which localized the bleeding spot on posteromedial aspect of his Right CCA. He underwent emergency surgery with repair of the defect and made an uneventful recovery post operatively.

Conclusion: Delayed post traumatic rupture of the CCA is an uncommon yet potentially life threatening condition which can be caused by unusual blunt injury mechanism. A high index of suspicion and low threshold for investigating carotid injuries in the setting of blunt trauma is likely to be beneficial.

No MeSH data available.


Related in: MedlinePlus

Intra operative picture showing (from above below): forceps holding the adventitia, Right Common Carotid Artery with localized perforation and Internal Jugular Vein.
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Figure 3: Intra operative picture showing (from above below): forceps holding the adventitia, Right Common Carotid Artery with localized perforation and Internal Jugular Vein.

Mentions: His neck was opened on the right side using a lazy S incision. On opening his platysma, there was a bulging haematoma which was rapidly expanding. Control of the Right common carotid was obtained proximally at the level of sternal head of sternomastoid by deflecting it, and distally at the level of bifurcation of common carotid. Omohyoid muscle was also divided for access. He was heparinised and the right CCA was clamped above and below the site of injury. Haematoma site was exposed by reflecting the internal jugular vein laterally and taking its multiple branches medially between clips. Vagus nerve was identified and protected. The point of perforation was in the posteromedial aspect of the artery, with surrounding adventitia appearing somewhat ragged, suggesting a stretch injury (Fig. 3). This appearance was consistent with rupture of a pseudo aneurysm. The arterial perforation site was extended in a cranio-caudal fashion to expose normal vessel wall. Examination of rest of the arterial wall appeared relatively normal with no evidence of true or mycotic aneurysm. Primary closure of the extended defect was carried out with polypropylene 6-0 suture in two layers (first layer – full thickness wall, second – periadventitia as reinforcement). The sternal head of sternocleidomastoid muscle was reattached.


Delayed rupture of common carotid artery following rugby tackle injury: a case report.

Thakore N, Abbas S, Vanniasingham P - World J Emerg Surg (2008)

Intra operative picture showing (from above below): forceps holding the adventitia, Right Common Carotid Artery with localized perforation and Internal Jugular Vein.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2277436&req=5

Figure 3: Intra operative picture showing (from above below): forceps holding the adventitia, Right Common Carotid Artery with localized perforation and Internal Jugular Vein.
Mentions: His neck was opened on the right side using a lazy S incision. On opening his platysma, there was a bulging haematoma which was rapidly expanding. Control of the Right common carotid was obtained proximally at the level of sternal head of sternomastoid by deflecting it, and distally at the level of bifurcation of common carotid. Omohyoid muscle was also divided for access. He was heparinised and the right CCA was clamped above and below the site of injury. Haematoma site was exposed by reflecting the internal jugular vein laterally and taking its multiple branches medially between clips. Vagus nerve was identified and protected. The point of perforation was in the posteromedial aspect of the artery, with surrounding adventitia appearing somewhat ragged, suggesting a stretch injury (Fig. 3). This appearance was consistent with rupture of a pseudo aneurysm. The arterial perforation site was extended in a cranio-caudal fashion to expose normal vessel wall. Examination of rest of the arterial wall appeared relatively normal with no evidence of true or mycotic aneurysm. Primary closure of the extended defect was carried out with polypropylene 6-0 suture in two layers (first layer – full thickness wall, second – periadventitia as reinforcement). The sternal head of sternocleidomastoid muscle was reattached.

Bottom Line: He was promptly intubated and had contrast CT angiography of neck vessels which localized the bleeding spot on posteromedial aspect of his Right CCA.Delayed post traumatic rupture of the CCA is an uncommon yet potentially life threatening condition which can be caused by unusual blunt injury mechanism.A high index of suspicion and low threshold for investigating carotid injuries in the setting of blunt trauma is likely to be beneficial.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Surgery, Middlemore Hospital, Auckland, New Zealand. nainoor@rediffmail.com.

ABSTRACT

Background: Common Carotid Artery (CCA) is an uncommon site of injury following a blunt trauma, its presentation with spontaneous delayed rupture is even more uncommon and a rugby tackle leading to CCA injury is a rare event. What makes this case unique and very rare is combination of all of the above.

Case presentation: Mr H. presented to the Emergency Department with an expanding neck haematoma and shortness of breath. He was promptly intubated and had contrast CT angiography of neck vessels which localized the bleeding spot on posteromedial aspect of his Right CCA. He underwent emergency surgery with repair of the defect and made an uneventful recovery post operatively.

Conclusion: Delayed post traumatic rupture of the CCA is an uncommon yet potentially life threatening condition which can be caused by unusual blunt injury mechanism. A high index of suspicion and low threshold for investigating carotid injuries in the setting of blunt trauma is likely to be beneficial.

No MeSH data available.


Related in: MedlinePlus