Five-Year Review of Pediatric Vascular Trauma Patterns and Management in Conflict Zones: Insights from Somalia.

BACKGROUND

Pediatric vascular trauma is uncommon but devastating, and risk is amplified in conflict zones with constrained systems. Evidence from Somalia is limited.

OBJECTIVE

To describe patterns, mechanisms, anatomic distribution, management, and outcomes of pediatric vascular trauma over five years at a tertiary referral center in Mogadishu.

METHODS

Retrospective study of patients ≤18 years with traumatic vascular injury (April 2019-April 2024). Variables included demographics, mechanism, injury site, time-to-presentation, procedures, transfusion, complications, limb salvage, and mortality. Diagnostics followed ATLS-guided pathways (clinical exam/Doppler/CTA). Standard open vascular techniques (primary repair, end-to-end anastomosis, interposition autologous vein/PTFE) were used. Ethical approval MSTH/16842.

RESULTS

Fifty-four patients were included (83.3% male; 70.4% aged 13-18). Penetrating injuries predominated (81.5%: firearms, blast, stab, shrapnel). Commonly injured vessels were brachial (25.9%) and superficial femoral arteries (22.2%). Primary repair (40.7%) and vein grafting (35.2%) were most used. Limb salvage was 98.1% (53/54); one in-hospital death (1.9%). Delayed presentation (>6 h) and associated injuries correlated with worse outcomes.

CONCLUSION

In Somalia's conflict context, pediatric vascular trauma is largely penetrating and limb-threatening but shows excellent limb salvage with timely surgery. Findings support earlier referral, blood-bank capacity, standardized imaging pathways, and advanced vascular training to further reduce mortality.