Unusual mechanism of vascular trauma: Femoral artery penetration by wooden stick and delayed repair case report.

INTRODUCTION AND IMPORTANCE

Penetrating vascular trauma in the pediatric population is uncommon but can lead to serious complications, especially with delayed presentation. Injuries involving the superficial femoral artery (SFA) are rare and pose diagnostic and management challenges, particularly in resource-limited rural settings. Retained foreign bodies such as wooden sticks further complicate vascular injuries and increase the risk of infection and thrombosis. Early recognition, thorough imaging, and timely surgical intervention are critical to favorable outcomes.

CASE PRESENTATION

A 14-year-old male from a rural area presented four days after a penetrating injury caused by a fall onto a wooden stick, resulting in localized swelling and persistent paresthesia of the left lower limb. Clinical examination revealed a monophasic Doppler signal and an ankle-brachial index of 0.4, indicating arterial insufficiency. CT angiography identified a short segment thrombosis of the SFA with a retained wooden foreign body adjacent to the vessel. The patient underwent emergency vascular repair with removal of the foreign body and reconstruction using a reversed great saphenous vein graft. Postoperative recovery was uneventful, with restoration of limb function and resolution of neurological symptoms.

CLINICAL DISCUSSION

Pediatric vascular injuries are rare and differ from adults in vessel size and response, complicating diagnosis and repair. Complete arterial transections may present with minimal bleeding due to vasospasm, delaying diagnosis. Imaging modalities such as CT angiography are essential for detecting vascular injury and retained foreign bodies. Autologous reversed saphenous vein grafting is a reliable and cost-effective option for arterial reconstruction in children. This case highlights the importance of maintaining clinical suspicion for vascular injury in delayed presentations and the role of advanced imaging and surgical management in resource-limited settings.

CONCLUSION

Delayed presentation of penetrating vascular trauma with retained foreign bodies can lead to significant morbidity if untreated. Prompt diagnosis using CT angiography and surgical repair with vein grafting can result in excellent limb salvage and neurological recovery, even in rural healthcare settings. Awareness and timely intervention are essential to optimize outcomes in pediatric vascular injuries.