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Jejuno-renal injury following traumatic hyperextension
Insights
A pediatric hyperextension spinal injury caused a rare small-bowel obstruction and renal artery tear. Prompt surgical intervention led to the child
Area of Science:
- Pediatric Traumatology
- Abdominal Surgery
- Nephrology
Background:
- Hyperextension spinal injuries are uncommon in children.
- Associated intra-abdominal and renal injuries present diagnostic and management challenges.
Observation:
- A 4-year-old boy sustained a hyperextension spinal injury.
- The injury resulted in anterior longitudinal ligament rupture, L1-L2 disc avulsion, small bowel herniation into the disc space, and an internal renal artery tear.
Findings:
- The pathophysiologic mechanism involves spinal hyperextension leading to disc space herniation of bowel.
- Simultaneous internal renal artery tear occurred.
- Surgical repair included uretero-ureterostomy and nephrostomy tube placement.
Implications:
- This case highlights a rare mechanism of small bowel obstruction secondary to spinal injury.
- Early diagnosis and surgical management are crucial for favorable outcomes in pediatric trauma.
- The patient achieved normotension, adequate renal function, and normal growth two years post-surgery.
Abstract:
A 4-year-old boy suffered hyperextension injury with small-bowel obstruction and renal injuries. This unusual constellation of findings is discussed in light of the pathophysiologic mechanisms of the injury. Hyperextension of the spine resulted in rupture of the anterior longitudinal ligament and avulsion of the L1-L2 disc; a loop of bowel was then drawn into the disc space. There also was an internal tear of the renal artery. Two years after uretero-ureterostomy with nephrostomy tube, the child is normotensive with adequate renal function and with normal growth and development.