Acute aortic occlusion in a child secondary to lap-belt injury treated with thromboendarterectomy and primary repair

Paraplegia After Seat Belt Abdominal Aorta Occlusion Associated With L4 Chance Fracture

Blunt traumatic injury to the chest or abdomen can produce injury to the aorta, which can compromise perfusion to the lower spinal cord. This report presents the case of a seat belt-restrained driver who sustained blunt abdominal trauma and progressive paraplegia. The trauma produced an acute occlusion of the abdominal aorta associated with an L4 Chance fracture and multiple bowel injuries. The Chance fracture occurred two levels below the aortic occlusion. The significant aortic atherosclerosis changes in this patient could have triggered the complete occlusion two levels above the fracture. An aortic injury associated with a vertebral fracture represents a severe and potentially lethal condition. Lower limb ischemia in the setting of a blunt abdominal injury could lead to a high diagnostic suspicion of abdominal aortic injury. Treatment of the vascular injury should be performed without delay to prevent or reduce permanent neurological deficits and ischemic injuries.

Subclavian artery reconstruction with femoral vein for ballistic injury in a 3-year-old boy

Few descriptions of using the femoral vein as an arterial replacement exist in the pediatric surgical literature. A 3-year-old child sustained a gunshot wound to the right subclavian artery, which resulted in ischemia to the upper extremity. The left femoral vein was harvested and used to reconstruct the subclavian artery. This report highlights a rare case of subclavian artery reconstruction using a femoral vein conduit in a young child after a penetrating injury.

Hospital mortality of blunt abdominal aortic injury (BAAI): a systematic review and meta-analysis

BACKGROUND

Studies on the mortality of blunt abdominal aortic injury (BAAI) are rare and have yielded inconsistent results. In the present study, we aimed to quantitatively analyse the retrieved data to more accurately determine the hospital mortality of BAAI.

METHODS

The Excerpta Medica Database, PubMed, Web of Science and Cochrane Library databases were searched to identify relevant publications without date restrictions. The overall hospital mortality (OHM) of BAAI patients was set as the primary outcome measure. English publications with data that met the selection criteria were included. The quality of all included studies was assessed by the Joanna Briggs Institute checklist and the American Agency for Health Care Quality and Research's cross-sectional study quality evaluation items. After data extraction, a meta-analysis of the Freeman-Tukey double arcsine transformation of data was performed using the Metaprop command in Stata 16 software. Heterogeneity was assessed and reported as a percentage using the I² index value and as a P value using the Cochrane Q test. Various methods were used to determine the sources of heterogeneity and to analyse the sensitivity of the computation model.

RESULTS

Of the 2147 references screened, 5 studies that involved 1593 patients met the selection criteria and were included. There were no low-quality references after assessment. One study that only included 16 juvenile BAAI patients was excluded from the meta-analysis of the primary outcome measure due to high heterogeneity. Due to the low heterogeneity (I² = 47.6%, P = 0.126 for Q test) that was observed after using the random effects model, the fixed model was subsequently used to pool the effect sizes of the remaining four studies, thus yielding an OHM of 28.8% [95% confidence interval (CI) 26.5-31.1%]. The stability of the model was verified by sensitivity analysis, and Egger's test (P = 0.339) indicated a low level of publication bias. In addition, we also performed meta-analyses and obtained a pooled hospital mortality of operation (13.5%, 95% CI 8.0-20.0%), a pooled hospital mortality of non-operation (28.4%, 95% CI 25.9-31.0%), and a pooled rate of aortic rupture (12.2%, 95% CI 7.0-18.5%) of BAAI.

CONCLUSIONS

The present study indicated that BAAI has an OHM of 28.8%, indicating that this disease deserves more attention and research.

Infrarenal aortic dissection in a child after blunt trauma

We present a 4-year-old who suffered blunt abdominal trauma leading to Chance fractures to the lumbar spine, bucket-handle injuries to the ileum and descending colon, and an aortic intimal injury leading to occlusion of the infrarenal aorta with extension to the bifurcation. Her vascular injuries were managed by endarterectomy of the intimal injury, thrombectomy of the distal aorta and bilateral iliac arteries using a Fogarty catheter, and patch angioplasty of the infrarenal aorta using bovine pericardium secured by a combination of interrupted and running sutures to optimize elasticity and operative time.

Pediatric blunt abdominal trauma: current management

PURPOSE OF REVIEW

Nonoperative management of pediatric blunt abdominal injury has changed significantly in the last few years.

RECENT FINDINGS

Improved resource utilization in the diagnosis of pediatric abdominal injury has been described. Hemodynamic status, rather than grade of injury, now guides care. Stable patients spend less time in the hospital, return to school upon discharge, and are allowed lower hemoglobin levels prior to transfusion. ICUs are reserved for those with recent or ongoing bleeding, previously unstable patients, or children with concomitant injuries necessitating ICU. Risk factors for failure and evidence for adjuncts to nonoperative management are emerging. Operative management of certain pancreatic injuries may have more favorable outcomes than nonoperative management.

SUMMARY

Sufficient evidence has become available to radically change the management of pediatric abdominal injury, which is being incorporated into new evidence-based management algorithms.

Endovascular management of lap belt-related abdominal aortic injury in a 9-year-old child

Blunt abdominal aortic trauma is a rare occurrence in children with only a few patients having been reported in the literature. Most such cases have been described in the context of lap belt injuries. We report a 9-year-old boy who suffered lap belt trauma to the abdomen during a high-speed road traffic accident resulting to the well-recognized pattern of blunt abdominal injury, that is, the triad of intestinal perforation, fractures of the lumbar spine, and abdominal aortic injury. The latter presented with lower limb ischemia due to dissection of the infrarenal aorta and right common iliac artery. Revascularization was achieved by endovascular means using 2 self-expanding stents in the infrarenal aorta and the right common iliac artery. This case is one of the few reports of lap belt-related acute traumatic abdominal aortic dissection in a young child and highlights the feasibility of endovascular management in the pediatric population.

F. A case study involving a blunt abdominal trauma leading to disruption of the aortic bifurcation in an infant

The incidence of aortic disruption secondary to blunt abdominal trauma is rarely reported in the pediatric population. In general, most of the cases described are the result of motor vehicle accidents. We report on the treatment and outcomes of a 5-year-old child with aortic bifurcation disruption secondary to an unusual case of blunt abdominal trauma who was admitted to the emergency room in hypovolemic shock and subjected to immediate exploratory laparotomy and vascular repair. The mechanical forces involved in aortic disruption and the management options for repair and treatment of this injury will be discussed.

Arterial injuries in extremities trauma, angiographic findings

At present, trauma is a common problem and regarded as the third cause of mortality in different societies. Significant part of injuries resulting from trauma is due to vascular damages. Tissue ischemia associated with vascular injuries is regarded as medical emergencies which can result in irretrievable ischemia if it continues for 6 h. Therefore, early diagnosis and quick treatment of vascular injuries are of high importance. In this cross sectional study, all trauma patients referred with possible vascular injury to angiography department of Tabriz Imam Khomeini Hospital from Apr. 2011 to Apr., 2012 underwent angiography. The results were compared with the similar studies conducted in other countries. Out of all patients, angiography detected vascular injury in 75 cases consisting of 93.7% of men and 5.3% of women. Motor vehicle (93.3%) especially motorcycles accidents were the most common cause of the damages. Leg was the most common site of trauma (62.2%) and associated fracture was seen in 86.7% of cases. Also, double fracture of leg was the most common associated fracture. Anterior tibial artery (36%) and complete arterial occlusion (62.7%) were the most common injured vessel and vascular injury, respectively. Vascular injuries are more common in young men (20-30 years old) mainly resulted from blunt trauma associated with motor vehicle especially motorcycle accidents. Leg and anterior tibial artery were introduced as the most common site and injured artery, respectively.