Bullet Vascular Injury at a Pediatric Age: A Two-Case Report from Saudi Arabia

Gunshot injuries are a rare cause of vascular injury in the pediatric age group, mostly occurring accidentally. They are very serious injuries and could even be life- or limb-threatening, even with slow- velocity bullets. Here, we report two cases of vascular injury induced by different types of weapons. The first case was a four-year-old boy who presented with a left axillary artery injury caused by a gunshot bullet. The diagnosis was made by a computerized tomography angiogram (CTA). CTA showed a pseudo-aneurysm and complete disruption of the left axillary artery at the upper limb. The injury was treated immediately with exploration of the axillary artery, debridement of the injured area of the artery, and repair with an interposition saphenous graft. Postoperatively, the patient did well with good healing of the wound and regained normal upper limb pulses. The second case was a 10-year-old boy who was shot with an air rifle from a very short distance. This caused the bullet to directly penetrate the left side of his neck and injure the anterior surface of the left common carotid artery (CCA). Initially, the CTA missed the diagnosis, but the injury was diagnosed by duplex ultrasound on the third day of admission, which showed a pseudo-aneurysm at the anterior surface of the left CCA. The patient did not manifest any neurological signs or symptoms. He underwent surgical exploration of the CCA, and primary repair of the small hole located at the anterior wall. The patient recovered well with no neurological events.