Journal of Trauma and Injury

Volume 29(2); June 2016

Original Article

Peripheral Arterial Injuries in Pediatric Age Group: Ahmed A R Ammar; J Trauma Inj. 2016;29(2):37-42. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.37

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PURPOSE
Arterial injury in children is a challenging problem for its special characteristics. It is rare even during warfare. This review described a personal experience in the management and outcome of acute pediatric arterial injuries of extremities.
METHODS
Thirty-six children below age of 13 years were studied during period from 2004 through 2014 in Iraq.
RESULTS
Male patients were 27 (75%) and female were 9 (25%). Seven to twelve years old was the most affected age group. The incidence of iatrogenic injuries was greater in infants and toddlers while penetrating injuries were the most common in older children. Upper limbs arteries were affected in 17 (47.2%) and lower limb in 19 (52.8%) patients. Hard signs were the commonest mode of presentation (83.3%). Lateral wall tear and complete transection were the most frequent types of arterial injury (36.1% and 27.8% respectively). The most frequent procedures performed were end-to-end anastomosis and lateral arteriorrhaphy. Surgical outcome was good. In 27 cases distal pulsations were regained. Seven cases had impalpable distal pulses but still viable limbs. Limb length discrepancy was detected in one case. One case was complicated with limb loss. No death was recorded.
CONCLUSION
Arterial injuries in children are age related. The proper treatment of arterial injuries in children requires high index of suspicion, early operative intervention and continuous postoperative follow-up throughout years of active growth. Angiogram has a limited role as a diagnostic tool in acute arterial injuries.

Summary

Citations

Citations to this article as recorded by

Traumatic brachial artery dissection in a pediatric patient: An interdisciplinary approach to care
Katherine Kazen, Jeremy Powers, Steven Hopkins, Brad Feltis
Journal of Pediatric Surgery Case Reports.2022; 85: 102403. CrossRef
Operative management and outcomes of peripheral vascular trauma in pediatric and adolescent population
Madhur Kumar, Subrata Pramanik, Anubhav Gupta
Indian Journal of Vascular and Endovascular Surger.2021; 8(5): 66. CrossRef
TREATMENT OF ARTERIAL TRAUMA IN PATIENTS OF VARIOUS AGES
Vitaliy Petrov, Roman Trutiak, Boris Dyachushun, Roksolana Yaremkevych, Ihor Kobza
Proceedings of the Shevchenko Scientific Society. .2021;[Epub] CrossRef
Peripheral Arterial Injuries in Children: An Audit at a University Hospital in Developing Country
Zia Ur Rehman, Amna Riaz, Zafar Nazir
Annals of Vascular Diseases.2020; 13(2): 158. CrossRef
Age differences of arterial trauma – Selection of the most appropriate age classification
Vitaliy Petrov
Polish Annals of Medicine.2020;[Epub] CrossRef
Operative management of non-iatrogenic pediatric and adolescence peripheral arterial trauma: An experience from a resource challenged setting
Ahmed Mousa, Ossama M. Zakaria, Ibrahim Hanbal, Tamer A. Sultan, Amr M. El-Gibaly, Mohamed Y. Zakaria, Mohammed A. Nasr, Bosat E. Bosat, Alaa Sharabi, Mohamed Neinaa, Mohamed Abd El-Hamid, Mohamed Y. Daoud, Mahsoub M. Amin, Ahmed M. Odeh, Omer M. Alhaieg,
Asian Journal of Surgery.2019; 42(7): 761. CrossRef

Case Reports

Right Diaphragmatic Injury Accompanied by Herniation of the Liver: A Case Report: Min A Lee, Kang Kook Choi, Gil Jae Lee, Byung Chul Yu, Dae Sung Ma, Yang Bin Jeon, Jung Nam Lee, Min Chung; J Trauma Inj. 2016;29(2):43-46. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.43

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Abstract PDF: Traumatic diaphragmatic injury (TDI) occurs in 1% of patients of blunt abdominal trauma. Most TDIs involve the left diaphragm, however the authors experienced TDI accompanied by a liver laceration of the right diaphragm. When detected early, TDI can be easily treated, however serious complications can occur if not. When diaphragmatic injury is suspected due to clinical manifestation, comprehensive analysis of the patient data including radiologic findings is important.; Summary

Successful TAE after DCS for Active Arterial Bleeding from Blunt Hepatic Injury in a Child: A Case Report: Chan Ik Park, Sang Bong Lee, Kwang Hee Yeo, Seungchan Lee, Sung Jin Park, Ho Hyun Kim, Jae Hun Kim, Chang Won Kim, Chan Yong Park; J Trauma Inj. 2016;29(2):47-50. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.47

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Abstract PDF

Transcatheter arterial embolization (TAE) for blunt hepatic injury in children is not common and is especially rare after damage control surgery (DCS). We report a successful TAE after DCS on a child for massive bleeding from the left hepatic artery due to a motor vehicle accident. The car (a sport utility vehicle) ran over the chest and abdomen of a 4-year-old boy. On arrival, initial vital signs were as follows: blood pressure, 70/40 mmHg; heart rate, 149/min; temperature, 36.7℃; respiratory rate, 38/min. After resuscitation, computed tomography was done, and a suspicious contrast leakage from a branch of the left hepatic artery and a spleen injury (grade V) were found. TAE was performed successfully after DCS for a liver injury.

Summary

Citations

Citations to this article as recorded by

Damage Control Surgery for Abdominal Compartment Syndrome Caused by Delayed Rupture of Hepatic Subcapsular Hematoma
Chan Yong Park, Kwang Hee Yeo, Ho Hyun Kim, Seon Hee Kim, Hyun Min Cho, Hoon Kwon, Chang Ho Jeon, Chang Won Kim, Seok Ran Yeom
Trauma Image and Procedure.2017; 2(1): 17. CrossRef

Isolated Traumatic Injury of the Pancreatic Head: A Case Report: Dong Hun Kim; J Trauma Inj. 2016;29(2):51-55. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.51

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Abstract PDF: Isolated injury to the pancreas after abdominal trauma is uncommon, and a delay in diagnosis and treatment can increase the morbidity and mortality. Therapeutic decisions with respect to pancreatic trauma are usually made based on the site of injury and the status of the pancreatic ductal system. In this report, we describe the surgical management of pancreatic head transection as an isolated injury following blunt abdominal trauma. A 55-year-old man presented with epigastric pain that radiated to the back. Abdominal computed tomography revealed a hematoma in the pancreatic head and upstream dilatation of the main pancreatic duct. Endoscopic retrograde cholangiopancreatography showed complete disruption of and contrast leakage from the main pancreatic duct in the pancreatic head region with a nonenhanced upstream duct. Emergency pancreaticoduodenectomy was successfully performed, and the patient was discharged on postoperative day 9 without any complications.; Summary

Simultaneous Surgery on Jejunum perforation with Pelvic Ring Fracture: A Case Report: Hoejeong Chung, Keum Seok Bae, Seong Yup Kim, Doosup Kim; J Trauma Inj. 2016;29(2):56-59. Published online June 30, 2016; DOI: https://doi.org/10.20408/jti.2016.29.2.56

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Abstract PDF: Patients with pelvic bone fractures with gastrointestinal perforations are reported in 4.4% of the cases and in very rare cases jejunum (0.15) is involved. However, intestinal perforations are often undiagnosed on the first examination before peritonitis is evident. We are presenting a report where a patient with anteroposterior compression injury, who was expected to undergo an internal fixation procedure, did not show any jejunum perforations on abdominal CT or other physical exams but was found on abdominal CT 1 week after right before surgery, therefore excision and anastomosis surgery, pelvic open reduction and internal fixation was simultaneously done with favorable results. In our case, we present a 61 year old male patient with liver trauma, adhesion at the abdominal cavity, with a past history of gallbladder excision, but without abdominal pain, fever, or infection symptoms. Therefore, this was a case that was difficult to initially diagnose the patient with jejunum perforation and peritonitis. The diagnosis was further supported during laparotomy when peritonitis around the area of intestinal perforation was observed. Generally, it is understood that pelvic bone fracture surgery is not immediately done on patients with peritonitis. However, this kind of patient who had peritonitis with intestinal adhesion and other complications could undergo surgery immediately as infection or other related symptoms did not coexist and the patient was rather stable, and as a result the treatment was successful.; Summary

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