EXTERNAL ILIAC ARTERY INJURY DURING SURGICAL DRAINAGE OF PSOAS ABSCESS: AN UNPRECEDENTED COMPLICATION Authors :Dr. Sayyed Ehtesham Hussain Naqvi ,Dr. Mohd Azam Haseen, Mohammed Hanif Beg ,Syed Shamayal Rabbani Department Of Cardiothoracic & Vascular Surgery J.N.Medical College,AMU, Aligarh

The authors disclose that they have not received any funding from any government/Non Government organisation for this study

IllioPsoas abscess(IPA) IPA) is a suppurative collection within the compartment of the psoas and iliacus muscles. IPA was once a common complication of tuberculous spinal infection but with advent of effective anti tubercular drugs non-tuberculous pyogenic IPA has become the predominant form. Primary IPA is seen in intravenous drug abusers or immuno compromised patients, while secondary IPA is caused by underlying conditions such as gastrointestinal or genitourinary tract diseases.

Introduction The triad of fever, flank pain, and limitation of hip movement, is noted in only 30% patients . Currently computed tomography (CT), and magnetic resonance image (MRI) & Gallium-67 scanning form the cornerstone of diagnosis. Medical therapy with/without Percutaneous drainage (PCD) or surgical intervention is the treatment. Complications like seroma, surgical site infection, chronic sinus has been reported .However, there is no case report of external illiac artery injury in English literature.

Anatomy of Illiopsoas area

Case report 11 year old male patient presented with complaints of fever and left flank pain for past 5 days. On examination he had a flexion deformity of left hip joint with tenderness near inguinal ligament. His USG was suggestive of multiloculated illiopsoas abscess . Patient was taken up for surgical drainage via anterior approach in a private nursing home under spinal anaesthesia . During surgery his left external iliac artery was cut and the operating surgeon ligated both the ends and shifted the patient to our institute.

Case report Patient was immediately explored and the EIA was badly crushed with its ends 5cm apart. Patients GSV was harvested and it was only 1.5mm in diameter so EIA was reconstructed using 5mm Dacron Graft (due to availability and financial constraints) Post operatively the patient improved well and was discharged on anticoagulants.

Conduit options Conduit Advantage Disadvantage Saphenous vein Easy availablity No life long anticoagulation Growth potential Disparity in size ePTFE Good size match Better graft profile life long anticoagulation costly No growth potential Dacron More turbulence Costly

CONCLUSION Iliopsoas abscess remains a therapeutic challenge. Since anatomy of Illiopsoas region is deformed special care should be taken during IPA drainage to avoid injury to vascular structures. In case of inadvertent injury expert opinion should be immediately sought to save the limb and life of patient.