Occlusion of left common iliac vein by a distended urinary bladder in a male with paraplegia due to spinal cord injury

Study design: A report of a male subject who sustained paraplegia at T-5 le vel due to spinal cord injury (SCI) 18 years ago, and in whom. occlusion of the left common iliac vein by a distended bladder was detected during a ro utine follow-up. Objectives: To illustrate a rare complication of chronic distension of the urinary bladder viz occlusion of the left common iliac vein. which persiste d even after providing adequate bladder drainage by intermittent catheteris ation. Setting: Regional Spinal Injuries Centre, Southport, UK. Methods: As part of a routine follow-up. we performed intravenous urography by injecting 50 ml of Ultravist 300 in a vein over the dorsum of the left foot. Opacification of collateral veins in the pelvis was seen in the 5- an d 10-min films., which suggested iliac venous occlusion. In order to confir m the diagnosis, contrast was injected intravenously in the left foot and v enography was performed. Results: Venography revealed a distended left common iliac vein with contra st flowing into the right internal iliac vein through collateral veins in t he pelvis; the right common iliac vein and inferior vena cava were patent. Duplex Doppler sonography showed compression of left common iliac vein by t he posterior wall of a distended bladder with absence of blood flow through the compressed segment. Computerised tomography (CT) confirmed the diagnos is of extrinsic compression of the left common iliac vein against the promo ntory of sacrum by a distended bladder. CT excluded other causes for iliac vein occlusion. Conclusion: In a male subject with SCI, chronic bladder distension produced occlusion of the left common iliac vein. Health professionals caring for i ndividuals with SCI should be aware that long-standing bladder distension c ould cause pressure effects upon adjacent structures in the pelvis.