Journal d'otologie et de rhinologie

Case Report: Stab Injuries in the Neck Involving the Innominate Artery

Ryohei Akiyoshi, Hiroaki Kanaya*, Wataru Konno, Takashi Kashiwagi, Hideki Hirabayashi and Shin-ichi Haruna

Case Report: Stab Injuries in the Neck Involving the Innominate Artery

Isolated innominate artery injuries caused by stab wounds are uncommon, but otolaryngologists may still encounter these injuries. The present report describes the case of an 80-yearold woman with a history of rheumatoid arthritis that was referred to our department after sustaining a stab injury to the innominate artery during a suicide attempt. On admission, she was hemodynamically unstable, and injury to the great vessels was suspected. Urgent surgical exploration through anterior neck incision was performed. Thoracic surgeons were consulted, because there was extensive hematoma in the neck and extending to the thorax with continuous active bleeding. A bleeding point was found in the distal part of the innominate artery, and the defect was immediately sutured with a prosthetic patch. Seven weeks after surgery, the patient presented with continuous oozing of blood from a posttraumatic aneurysm in the proximal part of the innominate artery. Emergent surgery was performed to achieve hemostasis and to replace the aneurysmal lesion with an interposition graft. Unfortunately, she expired intraoperatively due to uncontrollable bleeding. Vascular vulnerability based on systemic rheumatoid inflammation caused the outcome to worsen. Otolaryngologists should be aware that stab injury to the neck can result in death, even if the wound appears minor externally. The importance of diagnostic modalities, and cooperation with thoracic surgeons as well as the difficulty in predicting delayed complications followed innominate artery injury are discussed.

Isolated innominate artery injuries caused by stab wounds are uncommon, but otolaryngologists may still encounter these injuries. The present report describes the case of an 80-yearold woman with a history of rheumatoid arthritis that was referred to our department after sustaining a stab injury to the innominate artery during a suicide attempt. On admission, she was hemodynamically unstable, and injury to the great vessels was suspected. Urgent surgical exploration through anterior neck incision was performed. Thoracic surgeons were consulted, because there was extensive hematoma in the neck and extending to the thorax with continuous active bleeding. A bleeding point was found in the distal part of the innominate artery, and the defect was immediately sutured with a prosthetic patch. Seven weeks after surgery, the patient presented with continuous oozing of blood from a posttraumatic aneurysm in the proximal part of the innominate artery. Emergent surgery was performed to achieve hemostasis and to replace the aneurysmal lesion with an interposition graft. Unfortunately, she expired intraoperatively due to uncontrollable bleeding. Vascular vulnerability based on systemic rheumatoid inflammation caused the outcome to worsen. Otolaryngologists should be aware that stab injury to the neck can result in death, even if the wound appears minor externally. The importance of diagnostic modalities, and cooperation with thoracic surgeons as well as the difficulty in predicting delayed complications followed innominate artery injury are discussed.