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Mirande MH, Durhman MR, Bethel FB, Smith HF, Mirande RA. Pediatric rectal perforation repaired via endoscopic clipping: An alternative technique. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2022. [DOI: 10.1016/j.epsc.2022.102220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Godosis D, Kaselas C, Demiri C, Anastasiadis K, Tsiaprazi T, Spyridakis I. Traumatic perineal injury in a 13-year-old female: Case report and review of the literature. Pediatr Rep 2019; 11:7993. [PMID: 31281612 PMCID: PMC6589640 DOI: 10.4081/pr.2019.7993] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 06/17/2019] [Indexed: 11/23/2022] Open
Abstract
Traumatic perineal injury in children is a rather underestimated condition, in terms of occurrence. The rapid stretching of the soft perineal environment, combined with the surrounding osseous tissue of the pelvis, can cause severe injuries. The key to successful management of these injuries includes timely resuscitation, thorough physical examination and quick and safe repair of damages.
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Affiliation(s)
- Dimitrios Godosis
- 2 Department of Pediatric Surgery. Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Makedonia, Greece
| | - Christos Kaselas
- 2 Department of Pediatric Surgery. Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Makedonia, Greece
| | - Charikleia Demiri
- 2 Department of Pediatric Surgery. Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Makedonia, Greece
| | - Kleanthis Anastasiadis
- 2 Department of Pediatric Surgery. Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Makedonia, Greece
| | - Theodora Tsiaprazi
- 2 Department of Pediatric Surgery. Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Makedonia, Greece
| | - Ioannis Spyridakis
- 2 Department of Pediatric Surgery. Aristotle University of Thessaloniki, "Papageorgiou" General Hospital, Thessaloniki, Makedonia, Greece
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Sogut O, Boleken ME, Cevik M, Yavuz G. Severe Blunt Perineal Trauma in Children: A Retrospective Analysis of 28 Patients. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791101800508] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The current study was designed to determine the common mechanisms of blunt perineal trauma (BPI) and associated injuries in paediatric patient. The initial management and outcome concerning such injuries are discussed. Materials and methods The hospital records of 28 paediatric patients who were treated surgically between April 2004 and November 2010 because of BPI were reviewed retrospectively. The initial clinical examination under conscious sedation (EUCS) in each patient was performed by both an experienced emergency physician and a paediatric surgeon to obtain a complete physical examination. Results Among the 28 paediatric patients, twenty-two girls and six boys, aged 2 to 12 years experienced BPI. Fall onto a rough surface was the main cause for BPI in 21 patients (75%) and the rest had a motor vehicle-pedestrian crash. Five patients had concomitant anal or rectal injuries. There were concomitant urinary tract injuries in eight patients of whom three had combined lacerations or contusions of the perineum and disruption of the posterior urethra. There was concomitant complete rupture of proximal urethra from bladder in one patient. The remaining 4 patients with urinary tract injuries suffered from periurethral lacerations. The fifteen patients without anorectal or urethral injuries had concomitant vaginal or vulvar lacerations. Conclusion All paediatric patients who sustained severe BPI should be checked for multi-system trauma and those undergone routine EUCS to evaluate the extent of concomitant injuries should pay particular attention to the anorectal and urogenital tracts. Primary repair of such injuries is often recommended as the initial treatment of choice.
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Affiliation(s)
- O Sogut
- Harran University School of Medicine, Department of Paediatric Surgery, Sanliurfa, Turkey
| | - ME Boleken
- Harran University School of Medicine, Department of Paediatric Surgery, Sanliurfa, Turkey
| | - M Cevik
- Harran University School of Medicine, Department of Paediatric Surgery, Sanliurfa, Turkey
| | - G Yavuz
- Harran University School of Medicine, Department of Paediatric Surgery, Sanliurfa, Turkey
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The utility of presacral drainage in penetrating rectal injuries in adult and pediatric patients. J Surg Res 2017; 219:279-287. [DOI: 10.1016/j.jss.2017.05.056] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/15/2017] [Accepted: 05/17/2017] [Indexed: 11/24/2022]
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Samuk I, Steiner Z, Feigin E, Baazov A, Dlugy E, Freud E. Anorectal injuries in children: a 20-year experience in two centers. Pediatr Surg Int 2015; 31:815-9. [PMID: 26188926 DOI: 10.1007/s00383-015-3746-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2015] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Anorectal injuries in children are not frequently reported and their management is challenging. This report reviews the experience in managing this type of injuries in two medical centers over 20 years. METHODS An institutional database search for patients who were treated for anorectal injuries between 1994 and 2015 was undertaken. Twenty cases were located and medical records reviewed. This study was conducted with institutional review board approval (#572-14). RESULTS There were 6 girls and 14 boys with ages ranging between 1 and 15 years (mean 7 years). Eleven patients sustained penetrating trauma, while nine sustained blunt trauma. The mechanism of injury was variable and associated injuries were more common in blunt trauma. Most common presenting symptoms were rectal bleeding (n = 12) and anal pain (n = 11), followed by abdominal pain in six patients. Eighteen anorectal injuries were extraperitoneal and two intraperitoneal. Among patients with extraperitoneal injuries, 12/18 were managed by primary repair with (6) or without (6) fecal diversion and 2/18 by wound irrigation and drainage with fecal diversion and delayed repair. Four patients had superficial anal and perineal injuries that were irrigated and left to heal by secondary intention. Two patients with intraperitoneal rectal injuries underwent primary repair with fecal diversion. Follow-up period ranged from 2 weeks to 8 years (mean 2 years). There were three cases of wound infection, one case of suture line leak requiring reoperation and one case of vesicorectal fistula in a patient with combined trauma of the rectum and urinary bladder. There was no mortality. Fecal continence was preserved in all patients available for follow-up evaluation. CONCLUSIONS Primary repair of the perineal wound and anal sphincters can be performed safely in most cases given hemodynamic stability. Fecal diversion should be saved for cases with severe perineal involvement or cases with substantial associated injuries and concern of gross contamination.
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Affiliation(s)
- Inbal Samuk
- Department of Pediatric and Adolescent Surgery, Schneider Children's Medical Center, Sackler Medical School, University of Tel Aviv, Tel Aviv, Israel,
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Abstract
The leading cause of death in the pediatric population is trauma, of which pelvic injuries make up a very small percentage. Trauma to the pelvis can result in multiple injuries to the bony pelvis, rectum, bladder, and or the urethra. Although mortality in the pediatric population is typically secondary to associated injuries, pelvic hemorrhage can be a life-threatening event. The management of patients with complex pelvic injuries requires a multidisciplinary approach in order to achieve the best possible outcomes.
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Affiliation(s)
- Amita A Desai
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - Katherine W Gonzalez
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
| | - David Juang
- Department of Surgery, Children's Mercy Hospital and Clinics, Kansas City, Missouri, United States
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Abstract
BACKGROUND Complex injuries involving the anus and rectum are uncommon in children. We sought to examine long-term fecal continence following repair of these injuries. METHODS We conducted a retrospective review using our trauma registry from 2003 to 2012 of children with traumatic injuries to the anus or rectum at a level I pediatric trauma center. Patients with an injury requiring surgical repair that involved the anal sphincters and/or rectum were selected for a detailed review. RESULTS Twenty-one patients (21/13,149 activations, 0.2%) who had an injury to the anus (n=9), rectum (n=8), or destructive injury to both the anus and rectum (n=4) were identified. Eleven (52%) patients were male, and the median age at time of injury was 9 (range 1-14) years. Penetrating trauma accounted for 48% of injuries. Three (14%) patients had accompanying injury to the urinary tract, and 6 (60%) females had vaginal injuries. All patients with an injury involving the rectum and destructive anal injuries were managed with fecal diversion. No patient with an isolated anal injury underwent fecal diversion. Four (19%) patients developed wound infections. The majority (90%) of patients were continent at last follow-up. One patient who sustained a gunshot injury to the pelvis with sacral nerve involvement is incontinent, but remains artificially clean on an intense bowel management program with enemas, and one patient with a destructive crush injury still has a colostomy. CONCLUSIONS With anatomic reconstruction of the anal sphincter mechanism, most patients with traumatic anorectal injuries will experience long-term fecal continence. Follow-up is needed as occasionally these patients, specifically those with nerve or crush injury, may require a formal bowel management program.
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Abstract
Impalement injuries are uncommon, especially in the pediatric population. Because of the rarity of these injuries, physicians may have difficulty recognizing and treating impalement injuries appropriately. Clinical findings are sometimes innocuous, but can be life threatening. Therefore, evaluation of suspected impalement injury should involve careful history and thorough physical examination, even if there is no evidence of trauma to the perineum. We report a very rare case of rectum perforation after transanal introduction of a broomstick with almost no clinical findings. Impalement injuries are difficult to recognize, and severity may not be reflected by their external appearance. To diagnose these injuries in time, it is important to use a well-organized workup.
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Abstract
PURPOSE To discuss the presentation, management and outcomes of penetrating anorectal injuries at the Bustamante Hospital for Children. METHODS A retrospective review over an 11-year period (January 2001-December 2011) was undertaken. The data analysed were extracted from patients' case notes which were pulled based on the hospital's admission database. RESULTS Over the study period a total of 14 children presented with penetrating anorectal injuries. The medical records for one child were missing. The mean age at presentation was 6 years. Impalement by a metal spike was the mechanism of injury in 12 children, with one case of sexual assault. Three of the children had associated urogenital injuries. Ten rectal injuries were extraperitoneal. Five of the 13 cases (38 %) were managed with a colostomy-average time to closure was 6 months. There was one case of perineal wound infection and dehiscence. There was no mortality. CONCLUSION Selective fecal diversion in the form of a sigmoid loop colostomy is a safe and acceptable management option for children with penetrating anorectal injuries. The perineal wound itself can be closed primarily except in cases of delayed presentation.
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Gümüş M, Böyük A, Kapan M, Onder A, Taskesen F, Aliosmanoğlu İ, Tüfek A, Aldemir M. Unusual extraperitoneal rectal injuries: a retrospective study. Eur J Trauma Emerg Surg 2011; 38:295-9. [DOI: 10.1007/s00068-011-0163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 10/22/2011] [Indexed: 11/29/2022]
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Bonnard A, Paye-Jaouen A, Ilharborde B, Brasher C, Aizenfisz S, Sebag G, El Ghoneimi A. Lessons learnt from two pediatric motor vehicle accidents resulting in anal canal, rectal and gluteal muscle wrenching. Pediatr Surg Int 2011; 27:1135-9. [PMID: 21437699 DOI: 10.1007/s00383-011-2887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2011] [Indexed: 10/18/2022]
Abstract
Ano-rectal trauma is common in motor vehicle accidents involving children. Inadequate initial assessment of the extent of lesions may be life threatening. We describe two cases where children were struck by buses that subsequently rolled over them in the prone position, resulting in ano-rectal and gluteal muscle wrenching. The first patient was inadequately assessed. Initial management did not include a diverting stoma, leading to life-threatening necrosis and septic shock. The second benefitted from our previous experience and recovery was uneventful. The distinctive mechanism of trauma in true gluteal muscle and anal canal wrenching is discussed. Gluteal muscle, anal canal and rectal wrenching as a result of rolling force from a motor vehicle is a very serious condition requiring immediate intestinal diversion with a stoma. Immediate repair may be attempted at the same time as stoma creation if the patient is stable. Broad-spectrum antibiotics and close wound monitoring are necessary to avoid muscle necrosis and serious complications.
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Affiliation(s)
- A Bonnard
- Department of General and Urology Pediatric Surgery, Paris VII University, Robert Debré Hospital, APHP, 48, boulevard Sérurier, 75019, Paris, France.
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Abstract
Minimally invasive techniques have now become standard for the treatment of many surgical conditions in children. During the past decade, there has been increasing interest in the use of this technology for the management of injured children. Laparoscopy has become an important adjunct in the evaluation of both blunt and penetrating intra-abdominal trauma and frequently is both diagnostic and therapeutic. Laparoscopic techniques have been used to repair injuries involving the gastrointestinal tract, solid organs, and the diaphragm. These procedures have been performed successfully, and avoid the complications associated with formal laparotomy.
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Affiliation(s)
- Barbara A Gaines
- Division of Pediatric General and Thoracic Surgery, Children’s Hospital of Pittsburgh/UPMC, One Children’s Hospital Drive, 4401 Penn Avenue, Pittsburgh, PA 15224, USA.
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Travassos DV, Chrzan R, van der Zee D. Late Laparoscopic Management of Traumatic Rectal Injury Without Protective Colostomy. J Laparoendosc Adv Surg Tech A 2009; 19:843-4. [DOI: 10.1089/lap.2008.0335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Daisy V. Travassos
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - Rafal Chrzan
- Department of Pediatric Urology, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
| | - David van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center, Utrecht, The Netherlands
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