When Diabetes Complicates Diagnosis: A Rare Case of Blood Vessel Injury After Trauma

A 33-year-old man with poorly controlled Type 1 diabetes experienced a serious accident when crushed by a heavy object. The injuries were severe: broken ribs, sternum fractures, pelvic fractures, and internal bleeding in his abdomen. He also developed nausea, vomiting, and high blood sugar levels.

His medical team initially diagnosed diabetic ketoacidosis (DKA)—a serious condition where the body produces too much acid. They treated him with insulin, fluids, and medications to correct the metabolic imbalance. But something wasn't right: his gastrointestinal symptoms didn't improve, even after the DKA was corrected.

DKA and blood vessel injuries can cause similar symptoms, particularly nausea and vomiting. This overlap created a diagnostic puzzle. Doctors couldn't tell whether the persistent symptoms were coming from the metabolic crisis or from something else entirely—a hidden vascular injury.

Because the symptoms continued despite successful metabolic treatment, the medical team knew they needed to look deeper. They ordered advanced imaging studies: CT scans and CT angiography to examine the blood vessels in his abdomen.

The imaging showed severe narrowing of the celiac trunk—a major blood vessel that supplies the stomach and intestines—with approximately 80% blockage. The vessel had an unusual fish-hook shape and showed signs of extensive collateral circulation, meaning the body was trying to reroute blood around the blockage.

The imaging findings suggested a pre-existing underlying condition called median arcuate ligament syndrome (MALS), which may have become worse due to the trauma. However, the study notes that an acute traumatic injury to the blood vessel could not be entirely ruled out based on imaging alone.

This case demonstrates how Type 1 diabetes can complicate medical diagnosis. When patients present with both metabolic crises and physical injuries, symptoms may overlap in ways that mask the true underlying problem.

For patients with Type 1 diabetes who experience persistent symptoms after metabolic treatment, continued investigation is important. Persistent nausea and vomiting—even after DKA correction—warrant imaging to rule out serious vascular or other injuries that may require different treatment approaches.

Source: Frontiers in medicine. Evidence type: PubMed indexed literature. Type1Cure is an information and intelligence hub, not a medical advice service. This article summarizes published research and does not provide diagnosis, treatment, or personal medical guidance. Always talk to your own care team before changing anything about your Type 1 diabetes management.