Barbara Popek, Joanna PietrzykBarbara Popek, Joanna Pietrzyk

Tutors: Z. Jankowski, M.D., J. Jabłoński M.D., M. Lewandowska M.D.

Students' Scientific Group "Pediatric Surgery",   Department of Pediatric Surgery and Oncology, Medical University of Lodz

A rare case of a foreign body in the A rare case of a foreign body in the urinary bladder as a remnant of urinary bladder as a remnant of traumatic perforation of the rectum traumatic perforation of the rectum and urinary bladder.and urinary bladder.

Clinic Manager: Prof. Andrzejewska Ewa, PhD

Pediatric impalement injuries are:Pediatric impalement injuries are:

uncommon (the risk of overlooking!)uncommon (the risk of overlooking!)

the result of the result of accidental falls or sexual abuseaccidental falls or sexual abuse

http://fiat.auto.com.plwww.tuam.pl

CCasuisticasuistic c case reportsase reports of of combined perforation combined perforation of the rectum and bladder in the literatureof the rectum and bladder in the literature::

Johnson P A. Br Med. J. 1971; 2 (5764): 748-9. 9-year old girl with penetrating trauma resulting in perforation of the rectum, bladder and vagina

Bysiek A. with co- authors Bysiek A. with co- authors Rocznik Dziecięcej Chirurgii Urazowej.Rocznik Dziecięcej Chirurgii Urazowej. 9 (XXXI): 127-129.9 (XXXI): 127-129. 7-year-old boy7-year-old boy with with post-post-traumatic traumatic infraperitoneal infraperitoneal perforation perforation of the of the rectum and bladderrectum and bladder

Kim S with co- authors, Kim S with co- authors, JJ.. Pediatr Surg Pediatr Surg. 2006; . 2006; 4141(9):E1-3.(9):E1-3. 12- years old boy12- years old boy with with post-post-traumatic traumatic perforation of the rectum perforation of the rectum and bladderand bladder

Guha P with co- authors with co- authors J. Pediatr Urol. 2011; XX: 1-3. 6-year old boy with post-6-year old boy with post-traumatic traumatic perforation of the rectum perforation of the rectum and bladderand bladder

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- Urogenital septum lies more superficial- Urogenital septum lies more superficial- Bladder, uterus and rectum lie low in pelvis- Bladder, uterus and rectum lie low in pelvis- In girls rectovaginal septum is thinner- In girls rectovaginal septum is thinner

Pediatric impalement injuries:Pediatric impalement injuries:

http://www.google.plhttp://www.google.pl

Children may be predisposed to severe injuries:

Less awareness of the risks and consequences of injury

Anatomical differences:

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http://www.mp.pl/artykuly/?aid=56176

Pediatric impalement injuries:Pediatric impalement injuries:

Careful critical history and phisical examination Careful critical history and phisical examination

The absence of external physical findings The absence of external physical findings doesdoes nonot t exclude intraabdominal pathology.exclude intraabdominal pathology.

http://www.mp.pl/artykuly/?aid=56176

Aim of the study:Aim of the study:

      analyse of case of a foreign body analyse of case of a foreign body

in urinary bladder as a remnant of traumatic in urinary bladder as a remnant of traumatic perforation of the rectum and bladder perforation of the rectum and bladder

in 15 -year old boy. in 15 -year old boy.

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Case report (The 15 -year old boy):Case report (The 15 -year old boy):

Hospitalization in regional hospitalHospitalization in regional hospital::

First hospitalization (patient was intoxicated):First hospitalization (patient was intoxicated):

• maltreatment (burnsI/II, trauma to lumbar regio maltreatment (burnsI/II, trauma to lumbar regio and shoulder joint)and shoulder joint)

• laboratory tests and x-ray without deviationlaboratory tests and x-ray without deviation

• discharge from hospital discharge from hospital with a recommendation with a recommendation

for further outpatient carefor further outpatient care

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Second hospitalization in regional Second hospitalization in regional hospital:hospital:

• fever and abdominal pain fever and abdominal pain

• infection of urinary tract infection of urinary tract

• erytrocyturiaerytrocyturia

• gastritisgastritis

http://www.google.pl/imgres

Case report:Case report:

Transfer to Clinic of Pediatric Surgery Transfer to Clinic of Pediatric Surgery and Oncology: and Oncology:

http://www.rmf24.pl

Case report:Case report:

-- free fluid in the area of the spleen and between free fluid in the area of the spleen and between bowelsbowels

- - air under the diaphragm and in bladderair under the diaphragm and in bladder

• diagnostic imaging (usg, rtg, CT):diagnostic imaging (usg, rtg, CT):

• due to estalation of symptoms

• LaparotomyLaparotomy

Case report:Case report:

perforation of the rectum,perforation of the rectum, sigmoid colonsigmoid colon andand urinary urinary bladder (of ~1 cmbladder (of ~1 cm))

- eevacuatvacuation of aion of abscessesbscesses around the bowels and around the bowels and a a large amount large amount of purulent-fecal contentof purulent-fecal content

- ccolostomy and drainage into the peritoneal cavityolostomy and drainage into the peritoneal cavity

• Closure of colostomy in Closure of colostomy in the next stage of treatmentthe next stage of treatment

• Repeated treatment due to infections of the urinaryRepeated treatment due to infections of the urinary tracttract

• recurrent  infections of the urinary tractrecurrent  infections of the urinary tract

• suspicion of bipartite bladder or suspicion of bipartite bladder or diverticulitis of the diverticulitis of the bladderbladder (cystography, urography) (cystography, urography)

uroCT

Case report:Case report:

uroCTuroCT

The foreign body removed from the bladder:

Conclusions:Conclusions:

1.Lack of possibility of collecting information1.Lack of possibility of collecting informationabout nature of the trauma may cause delay in about nature of the trauma may cause delay in evaluation of the severity of injuries of the evaluation of the severity of injuries of the perineum. perineum.

2. Infections of the urinary tract after injury of the 2. Infections of the urinary tract after injury of the perineum are an indication for further diagnostics to perineum are an indication for further diagnostics to clarify the cause. clarify the cause.

3. There exists need for further educating physicians 3. There exists need for further educating physicians about necessity to direct patients after trauma to the about necessity to direct patients after trauma to the area of the perineum to surgical consultation. area of the perineum to surgical consultation.

Thank you for your attentionThank you for your attention