ABDOMINAL PELVIC VARICOSITIES DUE TO UNILATERAL COMMON AND EXTERNAL ILIAC VEIN OCCLUSION FIVE DECADES POST INJURY

Objectives: The patient is a 70-year-old male who was referred for evaluation of soft, distensible, anterior abdominal masses. He was a Korean War veteran, who in 1974 sustained a penetrating injury from fragments secondary to mortar explosion, requiring exploratory laparotomy. The patient was unable to recount his exact surgical history. Twenty years after the incident, he started noticing dilated superficial veins across his pelvis. At the time of presentation, nearly 5 decades after the initial injury, he was asymptomatic. On physical examination, he had a midline grouping of suprapubic varicose veins that were soft and compressible. He had minimal edema of the left leg, with no discoloration or ulceration present. No scrotal varices were noted. Pedal pulses were palpable bilaterally. Computed tomography (CT) scan showed extensive tubular structures in the anterior abdominal wall subcutaneous tissues, which were also present on CT imaging 12 years ago. He had been evaluated by vascular surgery over 10 years ago, at which time a lower extremity venous duplex showed a fully thrombosed/occluded left common and external iliac veins with extensive varicosed collateralization through the suprapubic region. Given that the patient was asymptomatic from this condition, no further surgical treatment was offered. He was advised to continue maintenance compression therapy with 20-30 mmHg “panty hose” garments. He was also counseled on the potential risk for hemorrhage should he undergo any future surgery requiring midline, flank, or retroperitoneal dissection. While there is a known case report of congenital absence of a common iliac vein in a young, healthy, athletic man who developed abdominal pelvic varicosities, this is the first case report of evolution of a traumatic injury of this nature over a lifetime. Pathophysiology, diagnostic modalities, management strategies, and potential clinical significance of abdominal pelvic varicose veins secondary to iliac vein occlusion from traumatic injury are discussed in this case report.

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