Delayed life-threatening aortic rupture after rib fractures: A case report

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, its role in the presence of vascular injury remains poorly documented. This case reveals the feasibility of staged management involving emergent aortic repair and subsequent rib stabilization. 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 hemoperitonea. Several hours later, 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 aortic laceration, which was repaired with primary suturing and pericardial patch reinforcement. 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 extubated on postoperative day 12 and 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. The favorable outcome supports an integrated surgical approach in selecting patients with complex thoracic trauma involving vascular structures.