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Bhosale M, Sangle A, Bhat G, Dambal P. Transanal Small Bowel Evisceration in a 3-Year-Old Victim of Motor Vehicle Accident. J Indian Assoc Pediatr Surg 2021; 26:253-255. [PMID: 34385770 PMCID: PMC8323572 DOI: 10.4103/jiaps.jiaps_124_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 06/01/2020] [Accepted: 08/23/2020] [Indexed: 11/11/2022] Open
Abstract
Although motor vehicle accidents (MVAs) in children are common, pediatric rectal perforations secondary to MVAs leading to transanal evisceration of the small bowel are very rare. Herniation of bowel through breach in the rectal wall seen eviscerating through the anus is a surgical emergency requiring laparotomy and necessary surgical procedure. We report case of a 3-year-old boy, victim of run-over MVA accident, presenting with bilateral fracture shaft femur, fracture of the left humerus, and transanal small bowel evisceration. About 30–40 cm long, gangrenous, small bowel loop was hanging outside the anal canal. Two consecutive surgeries were performed to manage this unusual and complex case with an excellent outcome. This report is presented for an extremely rare presentation of MVA injury in a child.
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Affiliation(s)
- Minakshi Bhosale
- Department of Pediatric Surgery, B J Government Medical College, Pune, Maharashtra, India
| | - Ameya Sangle
- Department of Pediatric Surgery, B J Government Medical College, Pune, Maharashtra, India
| | - Ganesh Bhat
- Department of Pediatric Surgery, B J Government Medical College, Pune, Maharashtra, India
| | - Praveen Dambal
- Department of Pediatric Surgery, B J Government Medical College, Pune, Maharashtra, India
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2
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Wellé IB, Mbaye PA, Séck NF, Ndoye NA, Guéye D, Lo FB, Ndiaye M, Sylla MA, Sagna A, Ngom G. [Transanal evisceration of small bowel caused by impalement in children: about a case]. Pan Afr Med J 2020; 37:320. [PMID: 33654538 PMCID: PMC7896525 DOI: 10.11604/pamj.2020.37.320.18332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Accepted: 02/21/2019] [Indexed: 11/23/2022] Open
Abstract
L'éviscération transanale de l'intestin grêle par empalement est exceptionnelle chez l'enfant. Nous rapportons l'observation d'un adolescent de 11 ans reçu à 2 heures d'une issue des anses grêles à travers l'anus suite à une chute avec réception sur un morceau de bois pointu. L'examen clinique avait objectivé un bon état général, une issue, par l'anus, d'environ 25 cm d'intestin grêle viable et un abdomen sensible dans son ensemble. Le bilan biologique préopératoire était normal et aucune imagerie n'était réalisée. Après une réanimation, l'exploration chirurgicale avait mis en évidence un liquide séro-hématique (300 ml) et une issue d'environ 60 cm d'anse grêle inflammatoire à travers une brèche d'environ 5 cm de la paroi antérieure du rectum. Une réduction des anses grêles éviscérées par traction douce, une réparation de la paroi rectale par des points séparés, une toilette et un drainage ont été réalisés. Le patient était sous antibiotique à large spectre. Les suites opératoires étaient simples avec une reprise du transit à J2 post-opératoire. La sortie a été autorisée à J7 post opératoire. Après un recul d'un mois, la patiente a été revue en consultation et l'examen clinique était normal.
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Affiliation(s)
| | | | - Ndéye Fatou Séck
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Ndéye Aby Ndoye
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Doudou Guéye
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Faty Balla Lo
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Modou Ndiaye
- Service de Chirurgie Générale, Hôpital de Ourossogui, Sénégal
| | | | - Aloise Sagna
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
| | - Gabriel Ngom
- Service de Chirurgie Pédiatrique, Hôpital d'Enfant Albert Royer, Sénégal
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Cawich S, Islam S, Harnarayan P, Young-Pong C. Abdominal wall disruption with evisceration after blunt trauma. BMJ Case Rep 2014; 2014:bcr-2014-203646. [PMID: 24899004 DOI: 10.1136/bcr-2014-203646] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Abdominal evisceration after blunt trauma is rare. We report a case in a 65-year-old man who was crushed by a lorry. Management of this uncommon condition is reviewed.
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Affiliation(s)
- Shamir Cawich
- Department of Clinical Surgical Sciences, University of the West Indies, St Augustine, Trinidad and Tobago
| | - Shariful Islam
- University of the West Indies, St Augustine, Trinidad and Tobago
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Gelas T, Combet S, Perinel J, Javouhey E, Mure PY. Transrectal small bowel evisceration after abdominal crush injury. J Pediatr Surg 2012; 47:e53-6. [PMID: 23164034 DOI: 10.1016/j.jpedsurg.2012.07.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Accepted: 07/20/2012] [Indexed: 11/17/2022]
Abstract
Transrectal small bowel evisceration (TSBE) is a rare entity that can occur after traumatic injuries. It has been described after impalement, sexual assault, blunt abdominal trauma, and swimming pool drain suction. The authors encountered such a case in a 4-year-old by following a crush abdominal injury. A laparotomy was performed. The eviscerated bowel was pulled inside the abdominal cavity, revealing the rectal perforation. A portion of devascularized ileum was resected, a primary bowel anastomosis was performed, and the longitudinal rectal laceration was repaired with a two-layered closure. There was no fecal soilage, and no protective colostomy was performed. The mortality and morbidity of TSBE are usually related with the severity and type of trauma. The mesenteric laceration and concomitant injuries can cause significant bleeding leading to a hemorrhagic shock and multiorgan failure.
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Affiliation(s)
- Thomas Gelas
- Department of Pediatric Surgery, Hospital Femme Mère Enfant, Hospices Civils de Lyon and Claude Bernard University, France.
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Corduk N, Koltuksuz U, Karabul M, Savran B, Bagci S, Sarioglu-Buke A. A rare presentation of crush injury: transanal small bowel evisceration. Case report and review of the literature. Pediatr Surg Int 2011; 27:1021-4. [PMID: 21190115 DOI: 10.1007/s00383-010-2817-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2010] [Indexed: 10/18/2022]
Abstract
Evisceration of the small intestine through the anus is an extremely rare event in children. We report a 2-year-old boy who sustained transanal small bowel evisceration associated with bilateral diaphragmatic rupture, left diaphragmatic herniation, and spinal cord injury without radiographic abnormality which happened after crushing by motor vehicle. We reviewed children with transanal small bowel evisceration and discussed etiological differences between children and adult. We also discussed the basic principles of management and follow up in these patients.
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Affiliation(s)
- Nergul Corduk
- Pamukkale University Medical Faculty, Denizli, Turkey.
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Jagodzinski NA, Weerasinghe C, Porter K. Crush injuries and crush syndrome — a review. Part 1: the systemic injury. TRAUMA-ENGLAND 2010. [DOI: 10.1177/1460408610372440] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Crush injuries can occur in large numbers following natural disasters or acts of war and terrorism. They can also occur sporadically after industrial accidents or following periods of unconsciousness from drug intoxication, anaesthesia, trauma or cerebral events. A common pathophysiological pathway has been elucidated over the last century describing traumatic rhabdomyolysis leading to myoglobinuric acute renal failure and a systemic ‘crush syndrome’ affecting many organ systems. If left unrecognised or untreated, then mortality rates are high. If treatment is commenced early and the systemic effects are minimised then patients are often faced with significant morbidity from the crushed limbs themselves. We have performed a thorough review of the English language literature from 1940 to 2009 investigating crush injuries and crush syndrome and present a comprehensive, two-part summary. Part 1: The systemic injury: In this part we concentrate on the systemic crush syndrome. We determine the pathophysiology, clinical and prognostic indicators and treatment options such as forced alkaline diuresis, mannitol therapy, dialysis and haemofiltration. We discuss more controversial treatment options such as allopurinol, potassium binders, calcium therapy and other diuretics. We also discuss the specific management issues of the secondary ‘renal disaster’ that can occur following earthquakes and other mass disasters. Part 2: The local injury: Here we look in more detail at the pathophysiology of skeletal muscle damage following crush injuries and discuss how to minimise morbidity by salvaging limb function. In particular we discuss the controversies surrounding fasciotomy of crushed limbs and compare surgical management with conservative techniques such as mannitol therapy, hyperbaric oxygen therapy, topical negative pressure therapy and a novel topical treatment called gastric pentadecapeptide BPC 157.
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Affiliation(s)
| | | | - Keith Porter
- Selly Oak Hospital, Raddlebarn Road, Birmingham B29 6JD, UK
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A 6-year-old boy presenting with traumatic evisceration following a bicycle handle bar injury: a case report. CASES JOURNAL 2009; 2:6315. [PMID: 19829784 PMCID: PMC2740083 DOI: 10.4076/1757-1626-2-6315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2009] [Accepted: 07/27/2009] [Indexed: 11/08/2022]
Abstract
We report the case of a 6-year-old boy presenting with small bowel evisceration following a fall onto a bicycle handle-bar. His case is presented, a review of the literature performed and interesting photos pre and post-op are presented.
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8
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Kim HJ, Hwang JS, Jung SH, Kang SH, Kim JH. Transanal Small Bowel Eviceration due to Traumatic Rectal Perforation. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2009. [DOI: 10.4174/jkss.2009.76.3.199] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Hyun Jin Kim
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jong Sung Hwang
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Sang Hun Jung
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Su Hwan Kang
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, Korea
| | - Jae Hwang Kim
- Department of Surgery, College of Medicine, Yeungnam University, Daegu, Korea
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9
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Transanal Small Bowel Evisceration: An Unusual Presentation of Rectal Impalement. Eur J Trauma Emerg Surg 2008; 34:606. [PMID: 26816288 DOI: 10.1007/s00068-008-7097-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2007] [Accepted: 06/05/2008] [Indexed: 10/21/2022]
Abstract
Traumatic transanal small bowel evisceration is a rare condition usually associated with suction injuries or blunt abdominal trauma. We report the first case of intestinal evisceration through the anus caused by penetrating trauma (rectal impalement). Additionally, we performed a literature review of all English language articles since 1970 concerned with traumatic transanal small bowel evisceration. Mechanisms of injury and the surgical management are discussed.
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