Delayed life-threatening aortic rupture after rib fractures: a case report

Aortic injury secondary to rib fractures is an extremely rare but life-threatening complication of blunt thoracic trauma. Most of the documented cases result in prehospital mortality or death shortly after arrival because of massive hemothorax. Although the surgical stabilization of rib fractures (SSRF) has become increasingly integrated into thoracic trauma care, there remains a lack of awareness regarding the potential for posteriorly displaced rib fractures to cause delayed aortic injury.

A 71-year-old female patient sustained multiple left posterior rib fractures and solid-organ injuries following a traffic accident. Initial management involved exploratory laparotomy and splenectomy for hemoperitoneum. Several hours later in the intensive care unit, a sudden massive hemothorax developed, and cardiac arrest occurred due to active bleeding from a descending aortic laceration caused by displaced posterior rib fragments. Emergency thoracotomy revealed a 6-mm descending aortic laceration with diffuse intramural hematoma, which was repaired with proximal aorta clamped. After opening adventitial layer, the intima layer was repaired primarily using 5-0 Prolene sutures. Bovine pericardium was used as a reinforcement patch to restore the integrity of the adventitial layer rather than as a pledget for the primary repair. Following hemodynamic stabilization, SSRF was performed to fix the displaced sixth and seventh ribs and prevent further complications with plates and screws (MatrixRIB™ system). The patient was discharged on postoperative day 19 in good condition without any complication.

This case illustrates a rare instance of survival following aortic injury induced by rib fractures and emphasizes the need for high clinical suspicion in similar presentations. Early vascular control combined with prompt rib fixation may reduce morbidity rates by restoring chest wall stability, improving respiratory mechanics, and preventing secondary complications.