Abstract
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.