Blunt abdominal aortic trauma in paediatric patients

Abstract

Background: Blunt abdominal aortic trauma (BAAT) is a very rare occurrence in children, with significant morbidity and mortality. Varied clinical presentations and sparse literature evidence make it difficult to define the proper management policy for paediatric patients.

Method: We report our centre's data on three consecutive children with BAAT managed between 2006 and 2010. A Medline search was also performed for relevant publications since 1966, together with a review of references in retrieved publications.

Results: Forty children (range 1-16 years) were included in our final analysis. Motor vehicle crashes (MVC) were the leading cause of injury (65%). The in-hospital mortality rate was 7.5% (3/40). Nine patients (22.5%) ended up with residual sequelae. Main primary aortic lesions were complete wall rupture (12.5%), intimal transection (70%) and pseudoaneurysm (15%). Twenty-eight children underwent aortic surgical repair (70%). Among the 12 non-operatively managed patients, 41.6% had complications, including one death.

Conclusion: Symptomatic lesions and complete ruptures should undergo immediate surgical repair. Circumferential intimal transections are at high risk of complication and should also receive intervention. Partial intimal transections and delayed pseudoaneurysms can be initially observed by clinical examination and imaging. Patients with these latter pathologies should be operated on at any sign of deterioration.

Keywords: Aortic injury; Aortic trauma; Blunt abdominal trauma; Children; Paediatrics; Seat-belt syndrome.