FALSE ANEURYSM in  the groin

A

   B

C

E

D

This 38  year old male presented to his family doctor with a peculiar history stating that he had suffered a puncture to his  right  groin from a small nail a few days  prior to the visit .An initial ultrasound was done which simply showed a small hematoma and the patient reassured.He presented to the emergency department about one week later with a tense tender pulsating mass in his right groin (A& B ). An ultrasound and duplex  were done.The diagnosis was obvious especially on video with color flow.The patient had a signifcant false aneurysm of his groin( C ).Clinical examination showed a pulsating mass with an ischemic foot with no palpable pulsationsThe patient denied drug abuse despite the presence  of several needle tracts up both arms ( D & E ).

  The history on this gentleman is interesting.He previously lost his left  leg above the knee to trauma.This failed to heal and he had several revisions due to recurrent abscess and osteomyelities.Staph aureus had been grown on several occassions.The patient was being treated for chronic pain syndrome and was on routine(q3 hourly) self administered injections.The supposed history was that these were administered subcutaneously.
 
  At the time of surgery the patient was found to have a large infected  hematoma.The artery had several old puncture sites plus a signicant laceration  with total disruption of the common femoral  bifurcation.Debridement would not allow patch or local repair. Subsequently the vessels were ligated after debrdement and an  external -mid superficial fenoral artery bypass was performed using his ipsilateral long saphenous vein through the infected field.

  Culture at surgery again grew staph aureus sensitive to Cephalosporins.The limb was salvaged with good distal pulsation..