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Introduction: A 32-year-old man presented with a single left lateral lower quadrant stab wound and pulsatile hemorrhage. Methods: The patient was taken immediately to the operating room for laparotomy and was found to have an expanding retropertioneal hematoma. Aortic occlusion did not slow progression. The left iliac artery could not be located. A femoral cut down and proximal control of the femoral artery was also not helpful. The hematoma was entered directly and the hemorrhaging area in the lateral psoas muscle was ligated. Results: The patient maintained palpable dorsalis pedis pulses throughout the procedure. Postoperatively, a CT (computed tomography) showed congenital absence of the left iliac artery with large retroperitoneal collateral vessels in the retroperitoneum that reconstituted in a normal femoral artery. The scan demonstrated the injury was to one of these large vessels. The patient was discharged home after and uneventful course. Discussion: Congenital malformations of the iliac artery are rare, and most are discovered incidentally on imaging. We report a case of injury to a collateral vessel resulting from a left iliac atresia. This had implications for controlling hemorrhage in this case. Knowledge of vascular anomalies is important for management of traumatic injury.

I Can't Find the Left Iliac Artery! Abdominal Stab Wound Leading to Uncontrollable Hemorrhage