Complete thrombosis of the abdominal aorta in a neonate with advanced lower limbs ischemia: Etiological diagnosis, prognosis, and surgical approach

Abstract

Introduction: Neonatal aortic thrombosis is a rare but some cases have been described in the literature. It is associated with high mortality. The main etiology is umbilical vessel catheterization, but others cause coagulopathy, so sepsis could not be excluded. We reported a case of thrombosis of the abdominal aorta at the advanced stage of bilateral lower limbs ischemia treated surgically. \nCase Report: At 41-week gestation, a newborn boy was born by vaginal delivery to a 28-year-old gravida II para II mother. He was transferred to the neonatal intensive care unit for neonatal icterus; fever associated with lower limbs’ (extremities’) coldness. Perinatal history was normal. Examination showed cold, cyanotic lower left limb, the right side was a cold, pale with toes necrosis. Bilateral abolition of femoral artery’s pulses, loss of sensibility was found. At the left limb there was mild to moderate motor impairment. No history of umbilical artery catheterization was reported. A contrast computed tomography (CT) scan revealed complete aortoiliac thrombosis. Echocardiogram revealed normal anatomy without intracardiac thrombus. Preoperative blood analysis showed hemostasis anomalies. Cytobacterioligical urine exam was found to be positive for Escherichia coli. The baby underwent aortoiliac thrombectomy via median laparotomy. A surgical procedure was successful with blood flow restoration and limb perfusion. Post-operative blood count showed signs of ischemia-reperfusion, which may cause an unfavorable post-operative survival in our baby. \nConclusion: In conclusion, thrombosis of the aorta in neonates is rare with multiples etiologies. Surgical thrombectomy can be performed uneventfully with the best recanalization of the aorta. Early diagnosis and adequate post-operative management are the determinants of surgical outcomes.