Pulsatile pseudoaneurysm: a delayed diagnosed with a risk of limb ischemic in toddler: a case report

Background: Pseudoaneurysm is a vascular injury complication in lower extremity that's rarely been reported, especially in toddlers. Should it not appropriately treated, it can lead to worst conditions and even limb ischemic. Case description: a 3-year-old toddler, presented in the emergency room (ER) of Dr. Zainoel Abidin General Hospital (RSUZA) with bleed wound in the left limb persistent active bleeding. The shattered glass hit the patient On the physical examination, we found bleeding wound on the medial malleolus region of left limb, a pulsatile mass on the palpation, history of active bleeding was positive. To confirm the diagnosis, we performed CT angiography showing a sac shaped vascular lesion measuring 2.8 x 2.2 x 2.8 cm of proximal segment of the left posterior tibial artery, suggesting a pseudoaneurysm. We performed open surgery with excision procedure and a clot was found in medial malleolus region. As a result of open surgery, the left medial malleolus region is red, indicating a good blood flow and the patient discharged from hospital 4 days after surgery with a good result. Conclusion: Pseudoaneurysm resulting from vascular injury or iatrogenic injury can lead on various serious complications. If pseudoaneurysm is not appropriately treated, it can even threaten the patient's life.