Traumatic hemipelvectomy in children: report on 2 survivors with urological involvement

Traumatic hemipelvectomy through the sacroiliac joint is a devastating injury, mainly because of motor vehicle accidents. Recent improvements in prehospital trauma care have increased the chances of survival for victims. Besides amputation of the lower limb, associated complications usually involve digestive and urological systems. We report on 2 pediatric patients from 2 different European countries. PATIENT 1: A 9-year-old boy suffered uprooting of his left lower limb, laceration of the rectum and anal sphincter, as well as an injury to distal urethra with partial loss of cavernous bodies. Initial management included a colostomy and an essay of contention by means of a polypropylene prosthesis that had to be removed in the following months. After several attempts at urethral reconstruction, he underwent a Mitrofanoff derivation. PATIENT 2: An 18-month-old girl lost her left lower limb and suffered severe lacerations of bladder and rectum. Among other measures, management included a colostomy, a skin graft, and 2 attempts at reconstruction of her bladder neck, including a modified Casale procedure (cecum and ileocecal appendix were in a high position that made a Mitrofanoff derivation impossible) and a Malone procedure. To the authors' knowledge, she would be the youngest reported survivor of this kind of injury.