IP257. Pediatric Blunt and Penetrating Abdominal Aortic Transections: Report of Two Cases

Abstract

Noniatrogenic vascular injury accounts for <1% of pediatric trauma. With <4% of these involving the aorta, there is a paucity of reports describing aortic injury in the pediatric population. We present two extremely rare cases of traumatic abdominal aortic transection and report the management and outcomes of both an open and an endovascular repair. Review and surveillance of the cases of two pediatric aortic transection patients were conducted at a level 1 trauma center. During a 12-year period, two children with trauma-related aortic transections presented to the emergency department. Both were hemodynamically unstable and taken directly to the operating room. An 11-year-old boy presented with a stab wound to the left flank. Injuries included penetration of the left kidney, transection of the aorta at the level of the right accessory renal artery, and injury to the inferior vena cava. The patient underwent reconstruction of the aorta using a Dacron interposition graft. He required nephrectomy, cava repair, fasciotomy, colon resection, colostomy, and prolonged renal replacement therapy. He was discharged home on postinjury day 38 without adverse vascular sequelae or need for further dialysis and underwent colostomy reversal at 5 months. Aortic duplex ultrasound at 7 months demonstrated questionable slight decrease in diameter at graft anastomotic sites but with normal flow throughout and without defect or stenosis. A 10-year-old boy involved in a motor vehicle crash, restrained only by a lap belt, presented with aortic transection at the level of the inferior mesenteric artery; he sustained multiple mesenteric rents, bowel injury, and lumbar spine fractures. The patient underwent endovascular repair of the aorta, fasciotomy, bowel resection, and delayed fusion of the lumbar spine. The patient was discharged home on postinjury day 36. At 4-year follow-up, imaging demonstrated satisfactory endograft position without growth complications of the aorta or child. This is a rare report detailing the management of penetrating abdominal aortic transections in two children. Both endovascular and open repairs are described with outcomes and follow-up.