Presentation on theme: "Barbara Popek, Joanna Pietrzyk"— Presentation transcript:
1 Barbara Popek, Joanna Pietrzyk A rare case of a foreign body in the urinary bladder as a remnant of traumatic perforation of the rectum and urinary bladder.Students' Scientific Group "Pediatric Surgery", Department of Pediatric Surgery and Oncology, Medical University of LodzClinic Manager: Prof. Andrzejewska Ewa, PhDTutors: Z. Jankowski, M.D., J. Jabłoński M.D., M. Lewandowska M.D.
2 Pediatric impalement injuries are: uncommon (the risk of overlooking!)the result of accidental falls or sexual abuse
3 Casuistic case reports of combined perforation of the rectum and bladder in the literature: Johnson P A. Br Med. J. 1971; 2 (5764):9-year old girl with penetrating trauma resulting in perforationof the rectum, bladder and vaginaBysiek A. with co- authors Rocznik Dziecięcej Chirurgii Urazowej.9 (XXXI):7-year-old boy with post-traumatic infraperitoneal perforationof the rectum and bladderKim S with co- authors, J. Pediatr Surg. 2006; 41(9):E1-3.12- years old boy with post-traumatic perforation of the rectumand bladderGuha P with co- authors J. Pediatr Urol. 2011; XX: 1-3.6-year old boy with post-traumatic perforation of the rectum
4 Pediatric impalement injuries: Children may be predisposed to severe injuries:Less awareness of the risks and consequences of injuryAnatomical differences:- Urogenital septum lies more superficial- Bladder, uterus and rectum lie low in pelvis- In girls rectovaginal septum is thinner
5 Pediatric impalement injuries: Careful critical history and phisical examinationThe absence of external physical findings does not exclude intraabdominal pathology.
6 https://poradnikinwestycyjny.wordpress.com/tag/cel/ Aim of the study:https://poradnikinwestycyjny.wordpress.com/tag/cel/ analyse of case of a foreign bodyin urinary bladder as a remnant of traumatic perforation of the rectum and bladderin 15 -year old boy.
7 Case report (The 15 -year old boy): Hospitalization in regional hospital:First hospitalization (patient was intoxicated):maltreatment (burnsI/II, trauma to lumbar regio and shoulder joint)laboratory tests and x-ray without deviationdischarge from hospital with a recommendationfor further outpatient care
8 Case report: Second hospitalization in regional hospital: fever and abdominal paininfection of urinary tracterytrocyturiagastritis
9 Case report: Transfer to Clinic of Pediatric Surgery and Oncology: due to estalation of symptomsdiagnostic imaging (usg, rtg, CT):- free fluid in the area of the spleen and between bowels- air under the diaphragm and in bladder
10 Case report:perforation of the rectum, sigmoid colon and urinary bladder (of ~1 cm)Laparotomyevacuation of abscesses around the bowels and a large amount of purulent-fecal contentcolostomy and drainage into the peritoneal cavityClosure of colostomy in the next stage of treatmentRepeated treatment due to infections of the urinarytract
11 Case report: recurrent infections of the urinary tract suspicion of bipartite bladder or diverticulitis of the bladder (cystography, urography)uroCT
14 Conclusions:1.Lack of possibility of collecting information about nature of the trauma may cause delay in evaluation of the severity of injuries of the perineum.2. Infections of the urinary tract after injury of the perineum are an indication for further diagnostics to clarify the cause.3. There exists need for further educating physicians about necessity to direct patients after trauma to the area of the perineum to surgical consultation.