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Five-Year Review of Pediatric Vascular Trauma Patterns and Management in Conflict Zones: Insights from Somalia
Abdijalil Abdullahi Ali1,2,3, Fatima Mohamud Ahmed3, Abdinafic Mohamud Hussein1
1Department of Cardiovascular Surgery, Mogadishu Somalia Türkiye Training and Research Hospital, Mogadishu, Somalia.
Insights
Pediatric vascular trauma in Somalia is mostly penetrating and limb-threatening. However, timely surgery achieves excellent limb salvage rates, highlighting the need for improved referral and training.
Area of Science:
- Vascular Surgery
- Pediatric Trauma
- Conflict Medicine
Background:
- Pediatric vascular trauma is rare but severe, with increased risk in conflict zones.
- Limited data exists on pediatric vascular trauma in Somalia.
Purpose of the Study:
- To analyze patterns, mechanisms, location, management, and outcomes of pediatric vascular trauma.
- To evaluate a five-year experience at a Mogadishu tertiary referral center.
Main Methods:
- Retrospective study of pediatric patients (≤18 years) with vascular injury (2019-2024).
- Data collected on demographics, injury specifics, treatment, and outcomes.
- Utilized advanced trauma life support (ATLS) diagnostics and standard open vascular repair techniques.
Main Results:
- 54 patients (83.3% male, 70.4% aged 13-18) were studied.
- Penetrating injuries (81.5%) were most common, affecting brachial and femoral arteries.
- Achieved 98.1% limb salvage with primary repair and vein grafting; one death (1.9%).
Conclusions:
- Pediatric vascular trauma in Somalia is predominantly penetrating and limb-threatening.
- Timely surgical intervention leads to excellent limb salvage rates.
- Recommendations include earlier referral, enhanced blood banking, standardized imaging, and advanced surgical training.
Background:
Pediatric vascular trauma is uncommon but devastating, and risk is amplified in conflict zones with constrained systems. Evidence from Somalia is limited.
Objective:
To describe patterns, mechanisms, anatomic distribution, management, and outcomes of pediatric vascular trauma over five years at a tertiary referral center in Mogadishu.
Methods:
Retrospective study of patients ≤18 years with traumatic vascular injury (April 2019-April 2024). Variables included demographics, mechanism, injury site, time-to-presentation, procedures, transfusion, complications, limb salvage, and mortality. Diagnostics followed ATLS-guided pathways (clinical exam/Doppler/CTA). Standard open vascular techniques (primary repair, end-to-end anastomosis, interposition autologous vein/PTFE) were used. Ethical approval MSTH/16842.
Results:
Fifty-four patients were included (83.3% male; 70.4% aged 13-18). Penetrating injuries predominated (81.5%: firearms, blast, stab, shrapnel). Commonly injured vessels were brachial (25.9%) and superficial femoral arteries (22.2%). Primary repair (40.7%) and vein grafting (35.2%) were most used. Limb salvage was 98.1% (53/54); one in-hospital death (1.9%). Delayed presentation (>6 h) and associated injuries correlated with worse outcomes.
Conclusion:
In Somalia's conflict context, pediatric vascular trauma is largely penetrating and limb-threatening but shows excellent limb salvage with timely surgery. Findings support earlier referral, blood-bank capacity, standardized imaging pathways, and advanced vascular training to further reduce mortality.
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