Online Exclusives
Early laparoscopic repair for blunt duodenal perforation in an adolescent
Duodenal perforation secondary to blunt abdominal trauma in children is rare and usually associated with delays in diagnosis and surgical intervention. The authors encountered such a case in a 12-year-old boy owing to his falling over the handlebar of a bicycle. Imaging examination showed that there was a perforation over the fourth portion of the duodenum without concomitant injuries. Using a 5-port transperitoneal laparoscopic technique, primary closure of the perforation was successfully performed at 6 hours after the impact.Delayed presentation of traumatic infrapopliteal arteriovenous fistula and pseudoaneursym in a 10-year-old boy managed by coil embolization
Blunt traumatic arteriovenous fistulae of the extremities are rare in children. We report the case of a 10-year-old boy with a traumatic infrapopliteal arteriovenous fistula and concomitant pseudoaneurysm diagnosed 2 months after he was struck by a car. It was definitively managed with coil embolization. Postprocedure, the vascular anatomy of the patient's right calf was well preserved. He had complete resolution of his symptoms immediately after the intervention and continues to do well 6 months later.Pediatric blunt vertebral artery injury: case report and treatment plan
Aggressive screening for blunt cerebrovascular injuries in patients with trauma has led to the identification and successful treatment of these injuries. We report the case of an 8-year-old boy who sustained a vertebral artery injury after a motor vehicle collision. Computed tomography angiogram showed an 8-mm thrombosed segment of the vertebral artery. The patient was initially anticoagulated with a heparin drip and transitioned over to treatment with enoxaparin sodium (Lovenox). With few reports in the literature of blunt cerebrovascular injuries in the pediatric population, a review of the appropriate screening parameters, treatment plans, and follow-up is helpful for the practicing physician.External-internal carotid artery transposition for repair of multiple pseudoaneurysms from penetrating injury in a pediatric patient
A 13-year-old boy was transferred to our trauma center after sustaining a shotgun wound to his neck and head. Workup revealed an injury to his tonsillar fossa, a pseudoaneurysm less than 4 mm in his internal carotid artery, and diffuse cerebral edema. After management of his intracranial hypertension, follow-up angiogram revealed 4 pseudoaneurysms in his internal carotid artery. In the operating room, the affected segment was resected, and a transposition of the external carotid artery to the internal carotid artery was performed.Bilateral ureteropelvic junction disruption in a 5-year-old boy
Ureteral injuries represent less than 1% of all traumatic genitourinary injuries. The rarity of traumatic ureteral injury is at least in part because the ureters are relatively well protected in the retroperitoneum. Ureteral injuries after blunt trauma are not common, and bilateral disruption of the ureteropelvic junction (UPJ) has only been previously reported in just one child. This is the first documented case of operative ureteral repair of bilateral complete UPJ disruption with double J ureteral stents in a child.Conservative management of a traumatic abdominal wall hernia after a bicycle handlebar injury (case report and literature review)
‘Handlebar hernia' is the name given to a specific type of traumatic abdominal wall hernia (TAWH). It is an uncommon injury, caused by impact of the abdominal wall against a blunt object, often bicycle handlebars. We present a case of handelbar hernia, discuss its investigation and treatment and suggest that immediate surgical repair may not always be required.Lung torsion after tracheoesophageal fistula repair: a case report and review of literature
Lung torsion is a very rare event that has been described after trauma, spontaneously, and post–thoracic surgery, with only 8 cases reported in the pediatric literature. We present the first case report of lung torsion complicating tracheoesophageal fistula repair. The diagnosis was suggested on chest ultrasonogram and Doppler and confirmed by computed tomographic scans. On exploration, a 90° rotation of the right middle and lower lobes in a clockwise direction was found. A complete interlobar fissure and an absent inferior pulmonary ligament were identified as predisposing factors.Isolated injury of the superior mesenteric artery caused by a lap belt in a child
Isolated vascular injuries are rare in cases of blunt abdominal trauma, and superior mesenteric artery injury is extremely rare but potentially lethal. The incidence of this kind of life-threatening injury has increased in recent years. The diagnosis of these isolated injuries is difficult, and its delay is associated with a higher morbidity and mortality. The authors report on the case of a child with an isolated injury of the superior mesenteric artery caused by a lap belt, during a motor-vehicle crash which was successfully managed.Preperitoneal pelvic packing in the child with an unstable pelvis: a novel approach
Combined external pelvic fixation and preperitoneal pelvic packing may represent a revolutionary management strategy for mechanically unstable pelvis fractures in critically injured patients.
