Blunt abdominal trauma - An important cause of portal venous pseuodoaneurysm

Area of Science:

• Vascular Surgery
• Pediatric Surgery
• Abdominal Imaging

Background:

• Portal venous system aneurysms and pseudoaneurysms are uncommon post-abdominal trauma.
• Most portal venous aneurysms occur in patients with liver disease and are often asymptomatic.
• Clinicians must recognize these as potential vascular complications of blunt trauma.

Purpose of the Study:

• To report a case of portal venous pseudoaneurysm following blunt abdominal trauma in a child.
• To emphasize the causal relationship between trauma and portal venous pseudoaneurysm.
• To discuss the diagnostic and management strategies for these rare vascular injuries.

Main Methods:

• Case report of a 10-year-old boy with a handlebar injury.
• Review of literature on portal venous aneurysms and pseudoaneurysms.
• Discussion of diagnostic utility of Doppler ultrasound.
• Consideration of management options: surveillance, conservative, surgical, and embolization.

Main Results:

• A clear causal link was established between handlebar trauma and portal venous pseudoaneurysm.
• Doppler ultrasound is a useful surveillance tool for asymptomatic cases.
• Complications like thrombosis, embolism, biliary compression, or hemorrhage often necessitate intervention.
• Transcatheter embolization is an option for managing complications or hemorrhage.

Conclusions:

• Portal venous pseudoaneurysms, though rare, are a significant vascular complication of blunt abdominal trauma.
• Early recognition and appropriate management, ranging from surveillance to intervention, are crucial.
• This case underscores the importance of considering vascular injury in pediatric blunt abdominal trauma.