Infrarenal aortic dissection in a child after blunt trauma

Abstract

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.

Keywords: Aortic dissection; Bucket handle bowel injury; Chance fracture; Pediatric; Seat-belt; Trauma.

Fig 1

Computed tomography (CT) abdomen and pelvis taken at the outside hospital about an hour after the accident. Axial and coronal views show the aortic injury whose extent was not fully appreciated before the patient was emergently taken to the operating room for damage control surgery. The bone window in the sagittal view demonstrates part of the Chance fracture at L4 (arrow) that was repaired 5 days after the accident.

Fig 2

Computed tomography (CT) angiogram of the abdomen and pelvis taken after the first operation and approximately 6.5 hours after the accident showing the occlusion of the infrarenal aorta.