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Ureteropelvic junction disruption following blunt abdominal trauma
Wolfgang Pumberger1, Elisabeth Stoll, Sylvia Metz
1Division of Pediatric Surgery, Department of Pediatric Intensive Care, University of Vienna, Austria.
Insights
A 7-year-old boy sustained a rare ureteropelvic junction avulsion after a car accident. Surgical repair was successful, highlighting this unusual traumatic injury in pediatric patients.
Area of Science:
- Pediatric Traumatology
- Urology
- Nephrology
Background:
- Blunt abdominal trauma can cause significant internal injuries.
- Avulsion of the ureteropelvic junction is an uncommon but severe consequence of high-energy impact.
- Pediatric patients present unique challenges in trauma management.
Observation:
- A 7-year-old boy experienced severe brain trauma and subsequent abdominal distension post-car accident.
- Initial assessment prioritized the brain injury, delaying abdominal trauma evaluation.
- Progressive abdominal distension prompted further investigation 24 hours after the incident.
Findings:
- Ultrasound and computed tomography (CT) scans confirmed a complete disruption of the ureteropelvic junction.
- The injury involved the separation of the renal pelvis from the ureter.
- Surgical intervention involved a simple primary anastomosis to restore urinary continuity.
Implications:
- This case underscores the importance of a high index of suspicion for intra-abdominal injuries in pediatric trauma, even with concurrent severe head injuries.
- Early diagnosis and prompt surgical management are crucial for favorable outcomes in ureteropelvic junction avulsion.
- Understanding the mechanisms and management of such rare injuries aids in improving pediatric trauma care protocols.
Abstract:
We report here on a case of avulsion of the ureteropelvic junction in a 7-year-old boy who was injured in a car accident. Severe brain trauma took precedence over signs and symptoms of blunt abdominal trauma, but 24 hours after the accident, progressive distension of the abdomen required further evaluation. Ultrasound examination and a computed tomography scan revealed disruption of the ureteropelvic junction. Simple primary anastomosis was performed. We discuss the characteristics of this unusual injury and include a review of the literature.