Pelvic abscess or pseudoaneurysm: diagnostic and therapeutic dilemma following iliac arterial trauma.

Intra-abdominal abscesses often complicate operations for abdominal trauma and are particularly dangerous in patients whose injuries involve major vessels. We report our experience with 10 patients who developed pelvic abscesses among 75 survivors of iliac arterial injuries. Pseudoaneurysms of primarily repaired iliac arteries occurred in 8 of these 10 patients. Emergency operations were required for acute arterial thrombosis or hemorrhage in four patients; massive hemorrhage that complicated the drainage of pelvic abscesses led to the recognition of the pseudoaneurysms in the other four patients. Three of the eight patients with pseudoaneurysm died of postoperative complications; ischemic extremity sequelae occurred in all five survivors. The association of pelvic abscesses with the complications iliac arterial repairs has not been previously emphasized. The integrity of an arterial repair should be arteriographically confirmed before proceeding with drainage of a pelvic abscess that developed after iliac arterial trauma.