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[Severe combined injury of the rectum and bladder in a child]
V P Gavrilyuk1, D A Severinov1, S V Kostin2
1Kursk State Medical University, Kursk, Russia.
Insights
Traumatic anorectal injuries in children are rare, lacking established treatment guidelines. This case report details successful surgical repair of combined rectal and bladder trauma in a pediatric patient.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Pediatric Urology
Background:
- Traumatic anorectal injuries are infrequent in pediatric surgical practice.
- Limited documented cases result in a lack of standardized treatment algorithms.
- Combined rectal and bladder trauma presents unique management challenges in children.
Observation:
- A 13-year-old male sustained a severe anorectal injury from a fall.
- Endoscopic and laparoscopic evaluations revealed a rectal wall laceration and posterior bladder wall damage.
- No evidence of penetrating abdominal injury was observed.
Findings:
- Successful surgical repair involved suturing rectal and bladder defects.
- A protective double-barreled sigmoidoscopy was created to facilitate healing.
- Subsequent cystography and fistulography confirmed successful repair prior to stoma closure.
Implications:
- This case highlights a successful surgical approach for combined pediatric rectal and bladder trauma.
- Demonstrates the feasibility of prompt surgical intervention and subsequent stoma reversal.
- Offers a potential management strategy for rare, complex pediatric anorectal injuries.
Abstract:
Traumatic anorectal injuries are rare in pediatric surgical practice. Only several similar cases are described in the world literature. This causes no generally accepted algorithms and tactics for these patients. We demonstrate successful surgical treatment of combined trauma of the rectum and bladder in a child. A 13-year-old boy was hospitalized after the child sat on the leg of an overturned chair. No evidence of penetrating abdominal injury was revealed. The boy underwent sigmoidoscopy under general anesthesia. We found a lacerated wound of anterior wall of the rectum measuring 1/3 of its diameter with damage to posterior wall of the bladder. Diagnostic laparoscopy revealed intact abdominal cavity. Wall defects were sutured (bladder wound was sutured during traditional cystotomy), and we formed protective separate double-barreled sigmostomy. In 3 months after discharge, the child was hospitalized for cystography and fistulography with subsequent closure of stoma. In long-term postoperative period (6 months), the quality of life is satisfactory. There is no pain and disturbances of urination.
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