AI-assisted detection of an initially missed infrarenal abdominal aortic injury in a polytrauma patient: A case report.

BACKGROUND

Blunt abdominal aortic injury (BAAI) is rare but carries high mortality. Traditionally, hemodynamically unstable polytrauma patients are rushed directly to the operating room; however, because BAAI is frequently missed during exploratory laparotomy, definitive diagnosis requires computed tomography (CT). The Hybrid Emergency Room System (HERS), which integrates resuscitation, surgery, interventional radiology (IVR), and CT imaging, enables rapid CT scanning even in hemodynamically unstable patients. Nevertheless, the risk of missing BAAI persists when resources for image interpretation are limited. To address this, CT screening AI software "ERATS" (ER Automated Triage System) was deployed at Osaka General Medical Center in September 2025. Here, we report a case demonstrating the utility of this AI system.

CASE PRESENTATION: A 29-year-old female presented in severe shock following a collision with a train. Initial resuscitation with resuscitative endovascular balloon occlusion of the aorta achieved transient stabilization, permitting CT scanning. Imaging revealed multiple life-threatening injuries: epidural hematoma, hemopneumothorax with multiple rib fractures, vertebral fractures, and pelvic fractures with active bleeding. A left chest tube was inserted, and pelvic transcatheter arterial embolization (TAE) was initiated. Immediately thereafter, ERATS alerted the trauma team to an abnormality in the abdominal aorta that was overlooked in the preliminary judgment. Re-evaluation confirmed an infrarenal abdominal aortic dissection with active extravasation. Emergency Endovascular Aortic Repair (EVAR) was performed immediately following the successful pelvic TAE, achieving hemostasis.

CONCLUSION

In the management of a severely injured polytrauma patient under resource-limited condition, AI-assisted CT diagnosis successfully identified an initially missed infrarenal abdominal aortic injury, enabling rapid hemostatic intervention.