Arterial Embolisation of Paediatric Mesenteric Pseudoaneurysm Secondary to Blunt Abdominal Trauma

Ruptured post-traumatic pseudoaneurysms of the superior mesenteric artery (SMA) are potentially life threatening and rarely reported in the paediatric population. The purpose of this report is to highlight the potential of endovascular treatment in this age group.

A 16 year old male presented to the emergency department (ED) with seizure like activity. He was hypotensive and tachycardic with worsening abdominal distension. Past medical history was significant for a motor vehicle accident 16 days previously for which he was hospitalised and underwent emergency surgery. During the previous hospitalisation the patient was found to have liver and renal lacerations, haemoperitoneum, and small and large bowel serosal injuries. At surgery, haemostasis of liver lacerations was achieved, a traumatic anterior abdominal wall hernia was repaired, and short segment small and large bowel resections with primary anastomoses were performed. The patient was discharged uneventfully from the outside hospital eight days prior to presentation. Computed tomography in the ED at presentation identified haemorrhage from a ruptured 2 cm SMA pseudoaneurysm. This was successfully treated by transcatheter microcoil embolisation. The patient was discharged uneventfully and was without abdominal complaints at the 29 month clinic follow up.

Post-traumatic SMA pseudoaneurysms in the paediatric population are rare; endovascular management may be a successful alternative or adjunct to surgical repair.