Recently, City Children’s Hospital received an AVL, male, 11 years old. Exploiting the history of the child playing with his brother, using sharp scisssors to accidentally pierce the left calf, causing a bleeding wound, the family took the child to a local hospital, cut and sutured the wound and monitored 4 The day I saw that my feet were swollen and not fake, painful, so I transferred to a provincial hospital, cut only the wound, pressed, transferred to the City Children’s Hospital. Here, the doctors examined: the child was awake and accessible, the popliteal wound (T) 2x1cm in the outer cheek area, the tip of the T toe was swollen, warm, the left dorsal pulse was palpable, the left posterior tibial pulse was difficult to catch, SpO2 left toe 96%, with weak pulse. Ultrasound shows left popliteal artery aneurysm. The entire superficial and deep vein system of the left leg has an arteriovenous vein spectrum. Contrast-enhanced CT scan showed:
- The stenosis of the end of the popliteal artery, before the bifurcation of the leg vessels, the size at the stenosis site d# 2.5mm, the posterior popliteal artery at the stenosis empties into the large aneurysm d# 22x15x18mm, from the aneurysmal aneurysm. This blood branched into all the arteries and veins of the leg including the anterior tibial and posterior tibial arteries. Note multiple branches of the collateral artery in the knee.
- Occlusion of the end of the hamstring at the site of aneurysm, the entire leg vein system, the great saphenous vein, the small saphenous vein, and the left femoral vein were contrasted very early at the same time as the artery due to receiving blood from the sac. arteriovenous aneurysms and via branches of the collateral veins of the knee and lower leg.
The doctors decided to open surgery to remove the muscle wound, reveal the left popliteal vascular system, and record a torn left popliteal artery on the 1cm bifurcation, creating a common vascular aneurysm. With an almost complete rupture of the vein, the restoration of the popliteal artery and the column of the popliteal vein is performed. After surgery, the child was transferred to the intensive care unit for active treatment with anticoagulants in combination with heparin, enoxaparine, aspirine, infusion of high-molecular-weight solutions for anticoagulation, and to maintain blood vessel circulation. The results after nearly 2 weeks of treatment, the child’s condition improved gradually, the legs stopped swelling and moved well, the dorsal and posterior tibial pulses were clear.
Through this case, we note that parents do not allow children to play with sharp objects, which can easily lead to unfortunate accidents affecting children’s health and even life.
Doctor 2 Nguyen Minh Tien
City Children’s Hospital