Ali Abdijalil Abdullahi, Mohamed Ahmed Omar, Ahmed Fatima Mohamud, Abdi Hassan Kalif, Keinan Halwo Bashir Adan, Ahmed Said Abdirahman
Department of cardiovascular surgery, Mogadishu Somalia Türkiye Training and Research Hospital, Somalia; Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia.
Department of cardiovascular surgery, Mogadishu Somalia Türkiye Training and Research Hospital, Somalia; Faculty of Medicine and Health Sciences, Jamhuriya University of Science and Technology, Mogadishu, Somalia.
Int J Surg Case Rep. 2025 Oct;135:111872. doi: 10.1016/j.ijscr.2025.111872. Epub 2025 Aug 26.
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.
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.
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.
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.
小儿穿透性血管创伤并不常见，但可导致严重并发症，尤其是就诊延迟时。涉及股浅动脉（SFA）的损伤罕见，给诊断和治疗带来挑战，在资源有限的农村地区尤为如此。诸如木棍等异物残留会使血管损伤更加复杂，并增加感染和血栓形成的风险。早期识别、全面的影像学检查以及及时的手术干预对于取得良好预后至关重要。
一名来自农村地区的14岁男性，在因摔倒在木棍上导致穿透伤四天后就诊，出现左下肢局部肿胀和持续感觉异常。临床检查显示单相多普勒信号，踝肱指数为0.4，提示动脉供血不足。CT血管造影显示SFA有一小段血栓形成，血管旁有一残留的木质异物。患者接受了急诊血管修复，取出异物并使用大隐静脉逆行移植进行重建。术后恢复顺利，肢体功能恢复，神经症状消失。
小儿血管损伤罕见，在血管大小和反应方面与成人不同，使诊断和修复复杂化。由于血管痉挛，完全性动脉横断伤可能出血极少，从而延迟诊断。诸如CT血管造影等影像学检查对于检测血管损伤和异物残留至关重要。自体大隐静脉逆行移植是儿童动脉重建的可靠且经济有效的选择。该病例强调了在就诊延迟时对血管损伤保持临床怀疑的重要性，以及在资源有限的环境中先进影像学检查和手术管理的作用。
伴有异物残留的穿透性血管创伤就诊延迟若不治疗可导致严重的发病率。使用CT血管造影进行快速诊断并采用静脉移植进行手术修复，即使在农村医疗环境中也可实现出色的肢体挽救和神经功能恢复。认识到这一点并及时干预对于优化小儿血管损伤的治疗结果至关重要。
