Gluteal artery aneurysms

Abstract

Two cases of gluteal artery aneurysm following penetrating trauma to the buttock are presented. Both cases were misdiagnosed as abscesses and were incised in the casualty area, resulting in massive haemorrhage. The surgical exposure for this pathology is discussed. Case reports Case IA 35-year-old man was seen in the casualty department 2 weeks after being stabbed in the right buttock. The buttock was swollen, inflamed, and painful. The diagnosis of an infected haematoma was made and an incision was performed over the pointing area. Torrential arterial bleeding followed and the systolic blood pressure dropped t o 60 mmHg within minutes. The bleeding was partly controlled by direct compression over the wound and the patient was taken to the operating theatre. A ruptured false aneurysm arising from the main trunk of the superior gluteal artery was found. Suture ligation of the feeding vessei was performed from inside the aneurysm. The patient was transfused intra-operatively with 6 units of blood. The postoperative recovery was uneventful.Case 2 A 22-year-old man was seen 3 weeks after a penetrating injury of the right buttock. The affected area was swollen, inflamed and painful. The lesion was thought to be an abscess and it was incised under local anaesthesia. Massive arterial bleeding followed and the blood pressure became unrecordable within minutes. Attempts to control the bleeding by direct compression over the buttock were unsuccessful. The wound was then extended and the cavity was tightly packed with a large swab. This manoeuvre was successful and the patient was taken to theatre where a ruptured aneurysm of the superior gluteal artery was found and the vessel was sutured-ligated. The patient was transfused with 5 units of blood intra-operatively. The postoperative recovery was uneventful.

Analytical review of 664 cases of penetrating buttock trauma

“…Case reports on penetrating buttock injury [6,8,19-33] highlight the importance of a thorough and aggressive evaluation of the patient [6], observation [23,27], prompt differential diagnosis [8,21,30,31], immediate assessment of the lower urinary tract [21,22], and lately the value of dynamic 2D and 3D CT-scanning and angiography [28]. They also highlight rare complications following high-velocity or low-velocity gunshot injury to the buttock where the bullet or pellet migrates to major veins such as inferior cava vein and hepatic veins [29] or if it reaches the right ventricle of the heart [23], needing a broad range of approaches ranging from open surgery to angioembolization [6,21,22], transjugular extraction of bullet from middle hepatic vein [29], image navigation surgery [33], gluteal surgery [28,32], laparoscopy [24], and laparotomy [6,20,21,25].…”

Inferior gluteal artery pseudoaneurysm mimicking gluteal abscess

“…The majority of these are pseudoaneurysms. The superior gluteal artery (large terminal branch of posterior trunk of internal iliac artery) is more commonly involved than the inferior gluteal artery (large terminal branch of anterior trunk of internal iliac artery) [2,3,8]. A gluteal artery pseudoaneurysm presents as an insidious onset, gradually progressive, post-traumatic swelling in the gluteal region, arising within a few weeks or months or years after the primary insult [1,2,9].…”

“…A gluteal artery pseudoaneurysm presents as an insidious onset, gradually progressive, post-traumatic swelling in the gluteal region, arising within a few weeks or months or years after the primary insult [1,2,9]. The swelling may show signs of infl ammation, may or may not be pulsatile and thus may very well mimic a gluteal abscess or might be erroneously diagnosed as sarcomata, lipomata, or hernia [8,9,10]. It might also present as compressive neuropathy of the sciatic nerve [3,9].…”

Anévrysmes mycotiques bilatéraux de l'artère fessière supérieure

“…7,14,15 Le contrô le de l'AII est obligatoire parce que si un saignement se produit, il est presque impossible de contrô ler l'art ere d'alimentation par un acc es extrapelvien exclusif. 2 Plusieurs auteurs ont donc propos e le clampage provisoire ou le contrô le par un ballon gonfl e dans l'AII. 16 Le traitement chirurgical est difficile techniquement ; la dissection par le gluteus maximus et le gluteus medius comporte le risque de l esion du nerf sciatique.…”