Post-traumatic Subserosal Small Bowel Herniation Leading to Obstruction in a Child with Acute Spinal Cord Injury
Nathaniel E Uecker1, Patrick J O'Neill2,3, Neal Agee1
1Division of Burns, Trauma, and Surgical Critical Care, Department of Surgery, Maricopa Medical Center, AZ, Phoenix, USA.
Insights
Lap belt use can cause varied small bowel injuries. Rarely, this injury presents as an obstruction due to mucosal herniation, as seen in a pediatric case with spinal cord injury.
Area of Science:
- Trauma surgery
- Pediatric surgery
- Gastrointestinal surgery
Background:
- Seatbelt injuries, particularly from lap belts, can lead to diverse small bowel damage.
- Small bowel obstruction is an uncommon presentation of lap belt-induced small bowel injury.
Purpose of the Study:
- To report a rare case of high-grade small bowel obstruction caused by lap belt injury.
- To highlight an unusual mechanism of obstruction in a pediatric patient with a virgin abdomen and acute spinal cord injury.
Main Methods:
- Case report of a pediatric patient with acute spinal cord injury.
- Description of the surgical findings and management of small bowel obstruction.
Main Results:
- The patient developed a high-grade small bowel obstruction.
- The obstruction was caused by herniation of intact mucosa and submucosa through a serosal tear, a rare complication of lap belt injury.
Conclusions:
- Small bowel obstruction can be a rare manifestation of lap belt injury.
- This case underscores the importance of considering unusual presentations of abdominal trauma in pediatric patients, especially those with spinal cord injuries.
Abstract:
The presentation of small bowel injury from lap belt use varies substantially, ranging from gross hemodynamic instability to insidious physiologic deterioration to simple failure of improvement. Rarely does small bowel injury manifest as an obstruction. This paper describes one such occurrence; in this case, herniation of intact mucosa/submucosa through a serosal tear caused a high-grade small bowel obstruction in a pediatric patient with an acute spinal cord injury and a virgin abdomen.
