Rare constellation of abdominal vascular injuries in blunt trauma: Left gastric artery pseudoaneurysms and dissection

Abstract

Introduction: Abdominal visceral artery pseudoaneurysms and dissections in blunt trauma are uncommon, however, solitary vascular injury of the left gastric artery and development of multifocal dissections are extremely rare with only 5 reported cases in the literature.

Presentation of case: A 79-year-old male presents two days after a motor boating incident in profound hemorrhagic shock. Subsequent CT imaging revealed moderate hemoperitoneum, two pseudoaneurysms of the left gastric artery measuring 6 mm and 9 mm, as well as attenuation of the artery in keeping with a focal dissection and intramural thrombus, and no active extravasation. After stabilization with blood product resuscitation, he was managed conservatively with administration of ASA and close monitoring.

Conclusion: Abdominal visceral artery vascular injuries in blunt trauma can be managed safely with close monitoring, antithrombotic agent, and medical co-morbidity optimization. Instability or worsening/ persistent symptoms should be considered for endovascular treatment or surgical ligation Further research and reporting of management approaches are required.

Keywords: Blunt trauma; Case report; Dissection; Left gastric artery; Pseudoaneurysm.

Fig. 1

CT Angiogram in the arterial phase demonstrating a 9 mm focal area of increased attenuation along the lesser curvature of the stomach representing a small pseudoaneurysm of the left gastric artery, with no active extravasation appreciated.

Fig. 2

CT Angiogram in the portal venous phase demonstrating stable pseudoaneurysms of the left gastric artery and interval development of left gastric artery attenuation in keeping with a focal dissection and intramural thrombus.

Fig. 3

In addition to the vascular injuries, the patient also had a severely comminuted, minimally displaced burst fracture of the T10 vertebral body resulting in 63% height loss. Retropulsion of the posterior inferior endplate of 2 mm and anterior displacement of the anterior vertebral body of 7 mm are also noted.