Surgical Burden of Traumatic Lower Limb Amputations in the Pediatric Age Group

Although the burden of traumatic lower limb amputation (TLLA) has been well described when it concerns the adult population, there is an evident scarcity in literature concerning this matter in the pediatric population. Our objective is to review the surgical burden and long-term outcome of lower limb amputation among pediatric trauma victims who have experienced lower extremity amputation as the result of an accident or injury. A PICO format was utilized. The population of interest includes only children and adolescents suffering TTLA. The generation of data to be reviewed was executed using MEDLINE and PUBMED. Altogether, all data that includes trauma in the pediatric population in the timeframe 1949-2019 was revised and yielded 13 observational studies. This systematic review includes statistical comparisons between the group of interest of this review and the adult population. Other comparisons include those between the different sources. Our outcomes include a consistent pattern. This consistency between different studies was opposed by certain contradictions. Disparity between the different reviewed studies was displayed in terms of the distribution of the most cited complications of TLLA among different sources and the frequency of additional surgery. The dichotomy in the results of the reviewed studies highlights a gap in the data relevant to TLLA in the pediatric population. In addition to the discrepancies in the available literature, the significant physio-anatomical differences between the pediatric and the adult populations which are relevant to TLLA highlight a requirement for further studies regarding TTLA in the pediatric age group.

A Bullet Injury to the Liver Complicated by Biliary Broncho Pleural Fistula and IVC Thrombosis: Case Presentation and Review for Management Guidelines

This is a case report of a 20-year-old male who presented to our hospital after sustaining a gunshot to the left upper abdominal quadrant with an exit right below the right scapula. On investigation, he was found to have a large right sided hemothorax and an extensive laceration in the liver. A right chest tube drain was inserted, initially drained blood and days later started draining bile. Consequently, the patient started coughing up bile and diagnosis of a biliary-broncho-pleural fistula was made. ERCP with sphincterotomy and stenting of a left hepatic duct injury was subsequently performed. The patient also developed an IVC thrombus that was discovered incidentally on follow up imaging and was treated with anticoagulation