Alomar Razan, Almunyif Raghad Mansour, Alnamshan Mohammed
College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia.
Division of Pediatric Surgery, Department of Surgery, King Abdullah Specialist Children Hospital, Riyadh, Saudi Arabia; College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia; Department of Pediatric Surgery, Department of Surgery, Ministry of the National Guard - Health Affairs, Riyadh, Saudi Arabia.
Int J Surg Case Rep. 2023 Jun;107:108338. doi: 10.1016/j.ijscr.2023.108338. Epub 2023 May 18.
Pseudo-aneurysm can be formed by iatrogenic factors, as well as non-iatrogenic factors. In the pediatric population, there have only been a few recorded incidences. The work has been reported in line with the SCARE criteria.
In our case, a five-year-old male who was medically free presented with a complaint of left foot swelling after a one-month history of glass trauma and two episodes of bleeding. Upon presentation to our facility, an examination of the left foot's dorsum revealed a 2.0 ∗ 2.0 cm pulsatile non-tender swelling with no symptoms of infection, and a healed scar. A lower limb arterial doppler ultrasonography was performed, and it revealed a 1 cm partially thrombosed pseudoaneurysm protruding from the Dorsalis Pedis Artery (DPA).
Lower extremity peripheral aneurysms, whether true aneurysm or a pseudo-aneurysm, are uncommon in adults and usually occur in the popliteal artery (70 %), femoral artery (20 %), and only (10 %) of aneurysms present in other locations (Dahman et al., 2021). This Condition is even extremely unusual in pediatric population, where only a few cases have been reported. Doppler ultrasonography was used as a radiological examination and a diagnostic approach in the case of our patient. Due to the rarity of this illness, there are no clear guidelines for approaching patients with similar symptoms.
A dorsalis pedis pseudoaneurysm should be considered in any traumatic injury that has resulted in a hematoma in the dorsum of the foot that is not healing. In our case, a primary aneurysm excision with DPA ligation appears to be a safe procedure with no effect on foot perfusion or function.
假性动脉瘤可由医源性因素以及非医源性因素形成。在儿科人群中,仅有少数病例记录。本病例报告符合SCARE标准。
在我们的病例中,一名五岁男性此前身体健康,在经历玻璃创伤一个月并有两次出血情况后,出现左脚肿胀的症状。到我院就诊时,对左脚背部进行检查发现一个2.0×2.0厘米的搏动性无痛肿胀,无感染症状,有一处愈合的瘢痕。进行了下肢动脉多普勒超声检查,结果显示一个1厘米的部分血栓形成的假性动脉瘤从足背动脉(DPA)突出。
下肢周围动脉瘤,无论是真性动脉瘤还是假性动脉瘤,在成人中都不常见,通常发生在腘动脉(70%)、股动脉(20%),只有10%的动脉瘤出现在其他部位(达曼等人,2021年)。这种情况在儿科人群中甚至极为罕见,仅有少数病例报告。在我们的患者病例中,多普勒超声检查被用作影像学检查和诊断方法。由于这种疾病罕见,对于有类似症状的患者没有明确的诊疗指南。
对于任何导致足部背侧血肿且不愈合的创伤性损伤,都应考虑足背假性动脉瘤。在我们的病例中,进行足背动脉结扎的原发性动脉瘤切除术似乎是一种安全的手术,对足部灌注或功能无影响。