TRAUMATIC AORTIC INJURY: IS THE SEATBELT TO BLAME?

Objectives: The most common cause of mortality in children (ages one to twenty-one) are trauma and accidental injury, with vascular and aortic injury being extremely rare. Traumatic aortic injury is most commonly encountered within the thorax and is relatively uncommon within the abdomen secondary to the relative protection due to its location within the retroperitoneum.

Methods:

Case Report:
10y/o female involved in a motor vehicle accident with a seatbelt sign. Exam revealed intact airway, BP 60/30, and HR 130s. She was emergently taken to the operating room for exploration, she was found to have multiple bucket handle injuries of the small bowel, a non-expanding Zone III retroperitoneal hematoma, and a Morel-Lavallee lesion of the abdominal wall. The patient was stabilized with damage-control laparotomy, bowel resection (>100 cm), partial colectomy, and abdominal packing with temporary abdominal closure and left in discontinuity. She was taking to the CT scanner with imaging revealing multiple injuries, notable for aortic transection/dissection at L3 and poor/no perfusion below this level. She was immediately taken back to the operating room for exploration of her abdominal aortic injury.

Results: Repair of abdominal aortic injuries have rarely been described in the pediatric population. Most repairs are performed with grafts, or primary repair alone. Endovascular repair for abdominal aortic injuries has been described. One of the concerns with endovascular approach in the pediatric population is the fixed diameter of stents which can predispose patients to long-term adverse outcomes secondary to lack of growth with the child's increasing vascular diameter with age.

Conclusion: Abdominal aortic injury in pediatric populations can be challenging as it is frequently accompanied by multiple injuries including the spinal column, pelvic fractures, and devascularization injuries of the intestines. Multiple types of repairs of abdominal aortic injuries have been described, but primary repair, patch angioplasty, and graft repairs are most commonly described. There is still much needed research regarding long-term outcomes within the pediatric populations, but due to the rarity of abdominal aortic injury, data is scarce