A Huge Pediatric Pseudoaneurysm in a 10-year Child After 5-month Missed Injury of the Popliteal Artery with Distal Limb Ischemia

Abstract Pseudoaneurysm is one of the most serious postoperative complications as its rupture may be fatal if not early detected. The diagnosis of pseudoaneurysm is usually delayed due to its nonspecific clinical features such as pain, swelling, skin bruises, or unexplained anemia that may be confused with other postoperative complications. The objective of this case study is to highlight the importance of prompt recognition and treatment that could be lifesaving. It is a case report of a 10-year male child with cerebral palsy that had corrective osteotomy with wires fixation 5 months ago. He presented to our department with a huge painful nonpulsatile swelling with subcutaneous bruises at his right distal thigh and knee region with impalpable distal pulses and signs of ischemia. Computed tomography angiography and magnetic resonance imaging showed a huge pseudoaneurysm (13 cm × 8.5 cm × 7 cm) connected to the popliteal artery with poor distal runoff. The patient was prepared for open surgical repair using extended medial approach to find that the anatomy was much distorted due to adhesions because of the huge size of the aneurysm. We opened the sac after proximal superficial femoral artery control to detect a considerably big severance at the posteromedial wall of the proximal part of the popliteal artery; however, successful primary repair was challenging, using end to end anastomosis. The patient had uneventful postoperative course and the limb was saved with good viability and functional outcome. In conclusion, we highlight the importance of early detection of the pseudoaneurysm by considering its possibility of as one of the serious postoperative complications. Open surgical repair is the standard treatment for pseudoaneurysms developed on the femoropopliteal axis, especially with such huge size, pediatric age group, and distal ischemia.