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Pediatric Abdominal Aortic Injury Following Blunt Trauma: A Case Report

Updated: Apr 15

VJM Spring Edition 2026

Authors: Sarah Deighan BS1, Patrick Conroy MD2, Katherine McMackin MD, MS2


Author Affiliation:

1Cooper Medical School of Rowan University, Camden, NJ 08103

2Department of Vascular Surgery, Cooper University Health Care, Camden, NJ 08103


Abstract

Blunt abdominal aortic trauma (BAAT) with abdominal aortic injury (AAI) is rare in children, where management is guided by limited case reports.1 Pediatric cases are frequented caused by motor vehicle crash (MVC) and are treated operatively.2 We report successful non‑operative management of low‑grade infrarenal BAAT in a child with concomitant life‑threatening intra‑abdominal injuries. Management included maintenance of normotensive blood pressure goals and regular neurovascular examinations, as well as planned, repeat computed tomography angiography (CTA). This case highlights that carefully selected, hemodynamically stable children with low‑grade infrarenal BAAT can be safely managed non‑operatively with structured surveillance, contributing evidence for a risk-stratified approach to pediatric aortic trauma.

 

Introduction

Blunt aortic injury is significantly more common in the thoracic cavity than the abdominal cavity. Pediatric BAAT is exceptionally uncommon and associated with significant morbidity and mortality.1 Restrained motor vehicle crash (MVC) is a common mechanism of pediatric blunt abdominal aortic trauma (BAAT).3 Due to low incidence, there is limited published data on the management of pediatric AAI.1 Primary treatment strategies in children include open surgical repair (OSR), endovascular aneurysm repair (EVAR), and non-surgical management.1,4,7-11 Reported complication rates following blunt abdominal aorta injury (AAI) are notable regardless of treatment modality.1 We present a rare case of non-operative stabilization of the abdominal aorta in a 7-year-old patient who was unrestrained in an MVC.  


Case Description

 A 7-year-old male with no past medical history presented as a passenger in a high-speed, head-on MVC, restrained by lap seat belt. On arrival, his Glasgow Coma-Scale (GCS) score was 15. He reported abdominal pain and right flank tenderness. Left posterior flank swelling lateral to the spine was noted on examination, concerning for traumatic lumbar hernia.  Transverse ecchymosis in a lap seat belt distribution (seatbelt sign) was also revealed on exam.


Computed tomography (CT) scan of the abdomen and pelvis showed a linear filling defect and adjacent fat stranding in the infrarenal abdominal aorta, consistent with intimal injury. Traumatic right inferior lumbar hernia and free fluid concerning for hematoma were also visualized. CT of the head and CT of cervical spine were unremarkable. The patient then underwent emergent exploratory laparotomy with small bowel and colonic resections and primary abdominal wall and right flank hernia repairs. Vascular surgery was consulted intraoperatively and recommended non-operative management of the aortic injury with immediate post-operative computed tomography angiography (CTA).


Immediately following surgery, femoral and dorsalis pedis pulses were palpable bilaterally, posterior tibialis signals were present, and sensory and motor function were intact. The patient continued to report stable abdominal pain. Post-operative CTA revealed circumferential intimal injury in the infrarenal aortic. Grade 1 blunt AAI, defined as intimal tear without intramural hematoma, was diagnosed.5 Based on current recommendations for Grade I AAI, conservative management was recommended; surgical repairs are indicated in Grade II-IV AAI.5,6 The patient was managed with normotensive blood pressure goals and hourly neurovascular examinations. A repeat CTA was obtained one day after presentation and again on day six. Repeat CTA showed stability and improvement of the intimal injury. Six months later, the patient did not report any clinical sequelae. Ultrasound images show no evidence of aortic aneurysm or dissection. He will continue to be followed for potential long-term sequelae including pseudoaneurysm formation, aortic stenosis or occlusion, and dissection progression based on recommended guidelines.1, 5, 6  


Discussion

The reported mortality and morbidity of pediatric blunt AAI are high, and management strategies are informed by adult experiences and a limited number of pediatric cases. Open surgical repair (OSR) remains the most frequently reported treatment strategy in pediatric cases of blunt AAI, with infrequent reports of endovascular repair in pediatric blunt AAI.1,4,6,8, 12 Concerns regarding long-term durability and the need for reintervention limit the use of endovascular techniques in the pediatric population.6 Even with operative management, mortality and morbidity remain substantial, underscoring the need for additional data to better define optimal treatment regimens for pediatric cases of blunt AAI.


In this case, a patient sustained a Grade 1 blunt AAI in the setting of life-threatening abdominal injuries. Consistent with current literature, priority was given to control of non-aortic injuries, with early vascular consultation and planned, repeat imaging.5,6 The decision of non-operative management was supported by hemodynamic stability, preserved distal perfusion, and low-grade nature of the injury. Conservative management of blunt AAI consisted of strict blood pressure control, frequent neurovascular examinations, and protocolized serial CTA in the acute period, followed by duplex ultrasound surveillance, all of which demonstrated stability and subsequent resolution of the injury without complications. This case adds to the limited pediatric literature supporting non-operative management of blunt AAI may in a carefully selected population of hemodynamically stable patients with low-grade injuries. Further reporting of pediatric cases and longer-term follow-up are needed to refine selection criteria and surveillance protocols for non-operative management of traumatic abdominal aortic injuries in children.

 

References

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  9. Mangold M, Chaves JM, Blewett C, Williams M. Infrarenal aortic dissection in a child after blunt trauma. J Vasc Surg Cases Innov Tech. 2022;8(2):129-131. Published 2022 Jan 27. doi:10.1016/j.jvscit.2022.01.002

  10. Swischuk LE, Jadhav SP, Chung DH. Aortic injury with Chance fracture in a child. Emerg Radiol. 2008;15(5):285-287. doi:10.1007/s10140-008-0722-5

  11. Blackstock CD, Jackson BM. Open Surgical Repair of Abdominal Aortic Aneurysms Maintains a Pivotal Role in the Endovascular Era. Semin Intervent Radiol. 2020;37(4):346-355. doi:10.1055/s-0040-1715881

  12. Nicholas NW, Shaw DR, Puppala S. Pictorial review on the endovascular management of paediatric aortic injuries. Br J Radiol. 2020;93(1106):20190017. doi:10.1259/bjr.20190017

 
 
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