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Presented by Hany Takla , MD General Surgery PGY4 University Of Massachusetts

Presented by Hany Takla , MD General Surgery PGY4 University Of Massachusetts. INJURY TO THE ABDOMINAL AORTA IN CHILDREN RESULTING FROM BLUNT TRAUMA. Aortic injuries. Rare Blunt Thoracic 0.1% Abdominal more unusual 0.05%. Pathophysiology. Rapid deceleration

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Presented by Hany Takla , MD General Surgery PGY4 University Of Massachusetts

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  1. Presented by HanyTakla, MD General Surgery PGY4 University Of Massachusetts INJURY TO THE ABDOMINAL AORTA IN CHILDREN RESULTING FROM BLUNT TRAUMA

  2. Aortic injuries • Rare • Blunt Thoracic 0.1% • Abdominal more unusual 0.05%

  3. Pathophysiology • Rapid deceleration • Damage to abdominal vessels by avulsion or intimal tear and subsequent thrombosis. • Direct anteroposterior crushing, against spine as occurs in car passengers wearing seat belts or from direct blows to the anterior abdomen. • Direct laceration of a major vessel by a bone fragment as occurs in severe pelvic or spine fractures.

  4. How many do we see? • What are the Patterns of Injury? • How do we manage it?

  5. Purpose • Critical aspects in the diagnosis and surgical management of children with BAAI. • Two cases with recommendations for management based upon a literature review.

  6. Methods • Intimal disruption or Partial Transection • CTA demonstrated a dilated segment of abdominal aorta at the level of L2-L3. • A review of the literature identified 22 prior cases of major blunt traumatic injury to the abdominal aorta in children aged <18 years.

  7. First patient

  8. Intact distal pulses • No evidence of end organ hypoperfusion • Relatively benign abdominal exam • Developed Peritonitis on HD#1 requiring Ex. Lap and Bowel resection.

  9. After discussion and repeat imaging , Aortic repair was performed in a separate setting on HD # 6 .

  10. Postop. Course • Uncomplicated.

  11. Second Patient

  12. Blunt abdominal Trauma secondry to handle bar injury. • Intimal disruption and transaction of the aortic wall at L2-L3 level.

  13. Results • Case I  Repair of Aorta with a Dacron patch. • Case II 1ry Repair with reimplantation of the IMA in the CIA.

  14. Postoperative follow up • Case 1 : 3 months Duplex • Case 2 : 3 weeks Duplex Demonstrated normal aortic diameter and blood flow.

  15. Decision Process Despite intact distal flow ,persistent Aortic intimal disruption and/Or dilatation with other Surgeons’ experience prompted the exploration.

  16. Literature review

  17. Literature review

  18. Literature review • Huang JT, Heckman JT, Gunduz Y, et al: Endovascular management of stenosis of the infrarenal aorta secondary to blunt abdominal aortic trauma in a multiply injured patient. J Trauma 66:E81-85, 2009 • Tracy TF, Jr., Silen ML, Graham MA: Delayed rupture of the abdominal aorta in a child after a suspected handlebar injury. J Trauma 40:119-120, 1996 • Pisters PW, Heslin MJ, Riles TS: Abdominal aortic pseudoaneurysmafter blunt trauma. J VascSurg 18:307-309, 1993

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