Surgical management of delayed hemorrhage from a post-traumatic false aneurysm of the peroneal artery at a forward medical evacuation point in the special military operation zone

This article presents a clinical case of a delayed complication following a shrapnel wound in a 30-year-old serviceman. The patient was admitted to a field military hospital one day after sustaining a wound to the left lower leg, with satisfactory distal blood flow. However, on the 7th day of hospitalization, profuse arterial hemorrhage developed, necessitating urgent surgical intervention. Ultrasound examination enabled the rapid diagnosis of the cause: the formation of a false aneurysm of the peroneal artery with mural thrombosis. Surgical intervention was performed, which included proximal control of the popliteal artery, exploration of the neurovascular bundle of the leg, opening of the aneurysmal cavity, thrombectomy, and isolation of the damaged vessel. Intraoperatively, a longitudinal rupture of the peroneal artery measuring 2 cm in length was identified, with the artery itself having a small diameter of less than 1 mm. Given the satisfactory pulsation in the main tibial arteries (anterior and posterior tibial), a reasoned decision was made to forgo reconstructive repair in favor of ligating the peroneal artery as a definitive hemostatic measure within the "damage control" concept. The postoperative course was uneventful. The patient was discharged with restored limb function and subsequently returned to active duty. This case clearly illustrates a typical scenario of a delayed, life-threatening complication of combat vascular trauma. It underscores the critical importance of vigilance for secondary hemorrhage, the indispensable role of ultrasound diagnostics at the forward medical echelon, and the rationale for choosing an organ-preserving strategy (ligation) for injuries to non-essential arteries in a field hospital setting.