Aortic bifurcation injury following blunt trauma presenting as bilateral lower limb ischaemia: a case report

Blunt abdominal aortic injury (BAAI) is rare but life threatening. Injury near the aortic bifurcation can cause acute lower limb ischaemia and is often associated with multisystem trauma, increasing morbidity and mortality. A 57-year-old man presented after being run over by a heavy vehicle, with right-sided rib fractures, pneumothorax, and intra-abdominal injury. In the secondary survey he was found to have absent lower limb pulses with neurological deficits. CT angiography revealed ESVS grade X injury at the aortic bifurcation and a grade I right renal injury. After transfer to a tertiary center, fasciotomy demonstrated a non-viable right lower limb and partially viable compartments in the left. The patient underwent resection of the injured distal aorta with polyester graft reconstruction and a right above-knee amputation, with controlled reperfusion. Despite initial hemodynamic stabilization, the patient developed severe reperfusion injury and multiorgan dysfunction syndrome postoperatively and died in the intensive care unit. BAAI is uncommon and complete aortic bifurcation occlusion is extremely rare. Patients with acute lower limb ischaemia and multisystem trauma have higher mortality than those with isolated or partial aortic injuries. Early recognition, prompt imaging, and urgent multidisciplinary surgical intervention are essential. However, prolonged ischaemia, reperfusion injury and systemic metabolic derangements often complicate management and can lead to poor outcomes even after aggressive surgery. Blunt aortic bifurcation injury carries high morbidity and mortality particularly when associated with multisystem trauma. Vigilance for early diagnosis, rapid intervention, and comprehensive critical care are vital although outcomes remain poor due to the risk of systemic complications such as reperfusion injury and multiorgan failure.