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Pediatric aortoiliac injury following blunt abdominal trauma: A case report
Edward Daniele1, Alan Coleman1, Ben Hirsch1
1Department of Pediatric Surgery, Department of Cardiovascular Surgery, Texas Tech University Health Sciences Center, 3601 4th Street MS 8312, Lubbock, TX 79430, United States.
Insights
Blunt traumatic abdominal aortic transection is rare, especially in children. This case highlights successful repair using bovine pericardium, offering a potential solution for this uncommon injury.
Area of Science:
- Vascular Surgery
- Trauma Surgery
- Pediatric Surgery
Background:
- Aortic injuries commonly result from motor vehicle accidents, primarily affecting the thoracic aorta.
- Abdominal aortic injuries from blunt trauma are significantly rarer than thoracic injuries, with limited pediatric case reports.
- Repair techniques and long-term outcomes for pediatric abdominal aortic injuries remain poorly defined.
Purpose of the Study:
- To report a rare case of pediatric abdominal aortic transection following blunt trauma.
- To describe the surgical repair using bovine pericardium for an abdominal aortic injury.
- To contribute to the limited literature on managing pediatric abdominal aortic injuries.
Main Methods:
- A 7-year-old boy sustained an abdominal aorta transection at the bifurcation extending into the left iliac artery after a high-speed motor vehicle accident.
- Surgical repair was performed using a bovine pericardium graft.
- The vessel's adventitia and intima were approximated over the bovine graft to ensure structural integrity.
Main Results:
- Successful surgical repair of the abdominal aortic transection was achieved using bovine pericardium.
- The patient's injury involved the aortic bifurcation extending into the left iliac artery.
- The repair technique involved approximating native vessel layers over the graft material.
Conclusions:
- Bovine pericardium serves as a viable material for repairing complex vascular injuries, demonstrating potential for tissue regeneration.
- Abdominal aortic repair in pediatric trauma remains a challenging area with limited established protocols.
- Further research is needed to evaluate long-term outcomes, including potential for stenosis or pseudo-coarctation, following bovine pericardium repair.
Introduction:
The most common mechanism of aortic injury involves motor vehicle collisions resulting in aortic disruptions, occurring almost exclusively in the chest. Injury to the abdominal aorta following blunt trauma is nearly twenty times less likely to occur than the thoracic aorta. Because of the low incidence, there are few reports regarding the presentation and repair of these particular injuries, especially in the pediatric population.
Presentation Of Case:
We present a case of a 7-year-old boy involved in a high speed motor vehicle accident with an abdominal aorta transection at the aortic bifurcation extending into the left iliac artery. The injury was repaired using bovine pericardium with the adventitia and intima of the vessel approximated over the bovine bridge.
Discussion:
Primary repair of thoracic aortic injury has been thoroughly described in the literature with good outcomes yet, abdominal aortic repair remains ambiguous. Few techniques and materials have been described with even less data surrounding the long-term outcomes.
Conclusion:
Bovine pericardium is a strong and stable acellular collagenous material with the potential to accelerate endothelialization and tissue regeneration. This remains an interesting field of research as stenosis and pseudo-coarction data have yet to be determined.
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