Seat Belt Aorta in a Paediatric Patient: Conservative Management with Eight Year Follow Up to Adulthood

Seat belt syndrome can cause blunt abdominal aortic injury (BAAI) in children. No specific guidelines exist for managing aortic injury in the paediatric population, presenting challenges due to ongoing somatic growth and vascular development.

A 10 year old girl sustained BAAI in a high kinetic motor vehicle collision (90 km/h). Initial computed tomography revealed a grade III infrarenal abdominal aortic injury (circumferential intimal dissection extended to the common iliac arteries). Focal dilatation measured 13mm at the aortic segment compared to 11mm proximally. Despite injury severity, the patient remained haemodynamically stable with adequate lower extremity perfusion. Conservative management with antihypertensive therapy and intensive duplex ultrasound surveillance was pursued. The eight year follow up showed an increase of the ectatic segment from 14 to 22 mm, stability of the left common iliac artery stenosis, and no target lesion intervention.

Conservative management may avoid intervention during somatic growth, circumventing complications of undersized devices, endoprosthesis migration, and peri-operative risks. Haemodynamically stable paediatric BAAI with contained injury may be managed conservatively with intensive surveillance. Multicentre case registries are needed to establish evidence based guidelines.