Delayed life-threatening aortic rupture after rib fractures: a case report.
4 affiliations
- 1Department of Surgery, Changhua Christian Hospital, Changhua City, Taiwan.
- 2Division of Cardiovascular Surgery, Department of Surgery, Changhua Christian Hospital, Changhua City, Taiwan.
- 3Department of General Surgery, Changhua Christian Hospital, Changhua City, Taiwan.
- 4Division of Thoracic Surgery, Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St, Changhua City, 500, Changhua County, Taiwan. [email protected].
Abstract
Background
Aortic injury secondary to rib fractures is an extremely rare but life-threatening complication of blunt thoracic trauma. Most of the documented cases result in prehospital mortality or death shortly after arrival because of massive hemothorax. Although the surgical stabilization of rib fractures (SSRF) has become increasingly integrated into thoracic trauma care, there remains a lack of awareness regarding the potential for posteriorly displaced rib fractures to cause delayed aortic injury.Case presentation
A 71-year-old female patient sustained multiple left posterior rib fractures and solid-organ injuries following a traffic accident. Initial management involved exploratory laparotomy and splenectomy for hemoperitoneum. Several hours later in the intensive care unit, a sudden massive hemothorax developed, and cardiac arrest occurred due to active bleeding from a descending aortic laceration caused by displaced posterior rib fragments. Emergency thoracotomy revealed a 6-mm descending aortic laceration with diffuse intramural hematoma, which was repaired with proximal aorta clamped. After opening adventitial layer, the intima layer was repaired primarily using 5-0 Prolene sutures. Bovine pericardium was used as a reinforcement patch to restore the integrity of the adventitial layer rather than as a pledget for the primary repair. Following hemodynamic stabilization, SSRF was performed to fix the displaced sixth and seventh ribs and prevent further complications with plates and screws (MatrixRIB™ system). The patient was discharged on postoperative day 19 in good condition without any complication.Conclusions
This case illustrates a rare instance of survival following aortic injury induced by rib fractures and emphasizes the need for high clinical suspicion in similar presentations. Early vascular control combined with prompt rib fixation may reduce morbidity rates by restoring chest wall stability, improving respiratory mechanics, and preventing secondary complications.
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BibTeX
@article{tseng2026delayed,
title = {{Delayed life-threatening aortic rupture after rib fractures: a case report.}},
author = {Li-Ning Tseng and Ying-Cheng Chen and Wei-Jung Chang and Ya-Fu Cheng},
journal = {Journal of cardiothoracic surgery},
year = {2026},
month = jul,
doi = {10.1186/s13019-026-04657-x},
url = {https://europepmc.org/article/MED/42897648},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Delayed life-threatening aortic rupture after rib fractures: a case report.
AU - Li-Ning Tseng
AU - Ying-Cheng Chen
AU - Wei-Jung Chang
AU - Ya-Fu Cheng
PY - 2026
DA - 2026/07/01
JO - Journal of cardiothoracic surgery
DO - 10.1186/s13019-026-04657-x
UR - https://europepmc.org/article/MED/42897648
AB - Background Aortic injury secondary to rib fractures is an extremely rare but life-threatening complication of blunt thoracic trauma. Most of the documented cases result in prehospital mortality or death shortly after arrival because of massive hemothorax. Although the surgical stabilization of rib fractures (SSRF) has become increasingly integrated into thoracic trauma care, there remains a lack of awareness regarding the potential for posteriorly displaced rib fractures to cause delayed aortic injury.Case presentation A 71-year-old female patient sustained multiple left posterior rib fractures and solid-organ injuries following a traffic accident. Initial management involved exploratory laparotomy and splenectomy for hemoperitoneum. Several hours later in the intensive care unit, a sudden massive hemothorax developed, and cardiac arrest occurred due to active bleeding from a descending aortic laceration caused by displaced posterior rib fragments. Emergency thoracotomy revealed a 6-mm descending aortic laceration with diffuse intramural hematoma, which was repaired with proximal aorta clamped. After opening adventitial layer, the intima layer was repaired primarily using 5-0 Prolene sutures. Bovine pericardium was used as a reinforcement patch to restore the integrity of the adventitial layer rather than as a pledget for the primary repair. Following hemodynamic stabilization, SSRF was performed to fix the displaced sixth and seventh ribs and prevent further complications with plates and screws (MatrixRIB™ system). The patient was discharged on postoperative day 19 in good condition without any complication.Conclusions This case illustrates a rare instance of survival following aortic injury induced by rib fractures and emphasizes the need for high clinical suspicion in similar presentations. Early vascular control combined with prompt rib fixation may reduce morbidity rates by restoring chest wall stability, improving respiratory mechanics, and preventing secondary complications.
SN - 1749-8090
ER -