Pediatric Bullet-Related Vascular Injuries: A Case Report of Two Incidents in Saudi Arabia

Pediatric vascular injuries caused by gunshot wounds are rare, often occurring due to accidents, and can be potentially life-threatening, even when caused by low-velocity projectiles. We present two cases of vascular trauma resulting from different types of weapons. The first case involved a 4-year-old boy who sustained an injury to the left axillary artery from a gunshot. A computed tomography angiogram (CTA) confirmed a pseudo-aneurysm and complete disruption of the artery. The child underwent immediate surgery, which included exploration, debridement, and repair of the artery with a saphenous graft. The child recovered without complications, with good wound healing and restored pulses in the affected limb. The second case was a 10-year-old boy who was shot in the neck with an air rifle at close range. The bullet penetrated the left side of his neck and injured the anterior portion of the left common carotid artery (CCA). Although the initial CTA failed to detect the injury, duplex ultrasound on the third day confirmed a pseudo-aneurysm in the CCA. The child showed no neurological symptoms and had a successful surgical repair of the injury, recovering fully without neurological complications.