MSS863: MANAGEMENT OF PENETRATING RETROPERITONEAL TRAUMA RESULTING IN TRAUMATIC AORTIC PSEUDOANEURYSM: A CASE REPORT
Michael T Olson, MD1; Yun Beom Lee, MD1; Jamie Neelon, MD2; Joseph C Broderick, MD2; Natalie Yass, MD2; Justin Sleeter, MD2; Theodore G Hart, MD1; 1Department of Vascular Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA; 2Department of Trauma Surgery, Brooke Army Medical Center, Fort Sam Houston, Texas, USA
Introduction: Penetrating injuries to the abdominal aorta are rare but can carry high mortality due to hemodynamic instability associated with rapid hemorrhage. Pseudoaneurysm formation can occur when the arterial wall is partially disrupted, creating a contained hematoma at risk of rupture. Prompt recognition and surgical intervention are critical.
Methods: We present the case of a 36-year-old male who sustained multiple gunshot wounds to the right anterior chest, right lateral chest, right mid-back, and left posterior flank in June 2025, found to have a traumatic aortic pseudoaneurysm on index trauma imaging.
Results: In the field, he was hemodynamically unstable, received 1 unit of whole blood and tranexamic acid, and had an attempted needle decompression of the right chest. On arrival to the trauma bay, he remained hemodynamically unstable with concern for tension physiology given diminished right-sided breath sounds. Emergent resuscitation in the trauma bay included additional blood products and placement of a 28-Fr thoracostomy tube, with rush of air and blood. Focused assessment with sonography in trauma exam was negative for abdominal free fluid. Computed tomography with angiography of the chest, abdomen, and pelvis notably revealed a right hemopneumothorax, multifocal distal abdominal aortic intimal injuries with a small pseudoaneurysm, retroperitoneal hematoma, and L4 ballistic spine injury. The patient underwent exploratory laparotomy with trauma and vascular surgery, revealing a zone 1 hematoma, which was explored to identify a distal IVC and aortic injuries with distal aortic pseudoaneurysm. The IVC injury was repaired primarily, and the distal aortic pseudoaneurysm was resected; the aortic bifurcation was reconstructed with a rifampin-soaked Dacron graft. Concurrently, a small bowel enterotomy was resected and two diaphragmatic injuries were repaired. Postoperatively, the patient was admitted to the ICU, extubated on postoperative day 1, and ultimately discharged home on postoperative day 12. Hospital stay was prolonged by urinary retention, ileus, and management of his right hemopneumothorax. At 3-month follow-up, he had no acute vascular complaints, and on exam had palpable distal pulses, a well-healed laparotomy incision, and no lower extremity swelling.
Conclusion: This case highlights the importance of rapid recognition, multidisciplinary surgical management, and vigilant postoperative care in penetrating abdominal aortic injuries. Open repair with rifampin-soaked Dacron grafts is a safe and effective option in young patients with injury location not amenable to endovascular treatment.
