Acute aortic occlusion in a child secondary to lap-belt injury treated with thromboendarterectomy and primary repair

Abstract

Abdominal aortic injury as a result of blunt trauma is a rare event and has been described in few children. A 6-year-old girl presented with acute bilateral lower extremity ischemia, and a triad of acute aortic occlusion, intra-abdominal visceral injury, and a lumbar chance fracture after sustaining a seat belt injury from a motor vehicle collision. An emergency aortic thromboendarterectomy and primary repair were performed. This represents one of the few reports of acute traumatic aortic thrombosis in a child and highlights the surgical treatment of acute abdominal aortic injury in a pediatric patient.

Pediatric blunt abdominal trauma

“…When it occurs, it is often associated with severe deceleration forces [63,64]. Concurrent injuries include lap belt injuries, Chance fractures, bowel injury, disruption of the cauda equina, and abdominal fascia disruption [65,66]. Endovascular management of children with blunt abdominal aortic trauma has been reported [61,64].…”

Endovascular Management of Lap Belt–Related Abdominal Aortic Injury in a 9-Year-Old Child

“…7,8 Delayed recognition has resulted in high rates of amputation, neurologic deficits, and death. 2,7,8 Two approaches have been documented in the literature with regard to the management of blunt abdominal aortic injuries in the pediatric population. A popular first choice is a conservative imagingeguided approach using serial computed tomography and Doppler ultrasound scans.…”

“…In children, such injuries are even more infrequent and may occur as a result of seat belt trauma to the abdominal wall in road traffic accident victims. 1,2 Surgical repair, particularly in the younger children, is extremely challenging and few vascular surgeons would have accumulated enough surgical experience in pediatric vascular surgery during their entire professional career. 1e3 We describe the endovascular management of a seat belterelated abdominal aortic injury in a pediatric patient.…”

A case study involving a blunt abdominal trauma leading to disruption of the aortic bifurcation in an infant

“…4,6 Blunt aortic lesions can range from an intimal flap to thrombosis, pseudoaneurysm formation, intramural hematoma, rupture or transection of the aorta and late aortic stenosis. 9,11 Pseudoaneurysms are the result of weakening of the aortic wall and are often diagnosed weeks or months after the initial trauma, either after the appearance of a palpable abdominal mass or through unrelated imaging. Aortic ruptures are less common.…”