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Thrombosis of the Abdominal Aorta in a Child After Blunt Trauma

Jacobi Medical Center Bronx, NY 10416

A 2.5-year-old boy was involved in a car crash. He shared the same seat belt with his mother. Abdominal distention and neurologic deficit of the lower extremities were noted immediately on admission. Abdominal CT was performed with oral and IV contrast material (Fig. 1A,1B,1C). Diminished peripheral pulses were not evident immediately after admission but were noted before the decision to perform a thrombectomy was made. During surgical exploration, a thrombosed abdominal aorta, extensive injury to the small bowel, and bilateral hernias were found. After thrombectomy, the femoral pulses returned to normal but paraplegia remained.

View larger version (105K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1A. —Thrombosis of abdominal aorta after blunt trauma in a 2.5-year-old boy. Enhanced CT scan shows aorta with normal lumen and no retroperitoneal hematoma. Hernia through right lateral abdominal musculature and small right renal infarct are seen.

View larger version (111K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1B. —Thrombosis of abdominal aorta after blunt trauma in a 2.5-year-old boy. Enhanced CT scan shows infrarenal aorta still has a normal lumen. Small retroperitoneal hematoma, thickened small-bowel loops in left upper quadrant, and hernia through left lateral abdominal musculature can be seen.

View larger version (138K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1C. —Thrombosis of abdominal aorta after blunt trauma in a 2.5-year-old boy. Enhanced CT scan obtained 10 mm caudad to B shows thrombus, which is slightly hyperdense, in aortic lumen, surrounded by small retroperitoneal hematoma. Thickened small-bowel loops and hernia through left lateral abdominal musculature are still visible.

Blunt traumatic injury to the aorta is a rare but potentially fatal injury [1]. In the few cases that have been reported, the aortic injury consists of tears distal to the infrarenal abdominal aorta, with the incidence (60%) of seat-belt injury predominating as the mechanism of the blunt injury in the adult [2]. Until 1999, fewer than 60 cases had been reported in all age groups. To my knowledge, fewer than five cases have been reported in children. The recent literature on blunt abdominal injuries in children from three different studies consisting of 539 children does not mention a single case of aortic injury [3,4,5]. The incidence of abdominal aortic injury is one twentieth compared with that of thoracic aortic injuries [1]. Most patients present with neurologic deficit (70%) and with decreased peripheral pulses (96%) [1], as in the present case. This case is the first of aortic injury resulting in thrombosis of the infrarenal abdominal aorta that I have been able to identify.

References

1. Reisman JD, Organ AS. J Trauma 1990;30;1294 -1297[Medline]
2. Chandler CF, Lane JS, Waxman KS. Seatbelt sign following blunt trauma is associated with increased incidence of abdominal injury. Am Surg 1999;63;885 -888
3. Neish AS, Taylor GA, Lund DP, et al. Effect of CT information on the diagnosis and management of acute abdominal injury in children. Radiology 1998;206;327 -331[Abstract/Free Full Text]
4. Ruess L, Sivit CJ, Eichelberger MR, Gotschall CS, Taylor GA. Blunt abdominal trauma in children: impact of CT on operative and nonoperative management. AJR 1997;169;1011 -1014[Abstract/Free Full Text]
5. Sjövall A, Hirsch K. Blunt abdominal trauma in children: risk of nonoperative treatment. J Pediatr Surg 1997;1169 -1174

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This Article Figures Only Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kory, L. A. Search for Related Content PubMed PubMed Citation Articles by Kory, L. A. Social Bookmarking                      What's this? Hotlight (NEW!) What's Hotlight?