Multiple stab injuries in an infant with silent bowel perforations: a case report
DOI:
https://doi.org/10.18203/2349-2902.isj20184098Keywords:
Abdominal trauma, Gastric perforation, Ileal perforation, Infant trauma, Multiple stab injuries, Pediatric penetrating traumaAbstract
Penetrating injuries of the abdomen occur rarely in infants and are mostly accidental. Non-accidental injuries are very rare. We report an infant boy who was stabbed by his father, at sixteen sites all over his abdomen and chest, with a pair of scissors. The child was clinically stable on presentation but omentum was seen protruding from one of the stab wounds. There was no evidence of peritonitis and imaging was normal. The stab wounds were explored, and laparotomy was performed. Intra-operatively, there was a sealed gastric perforation, a mesenteric tear and a long ileal laceration, which were all repaired primarily. In our case, though imaging was normal, a high clinical suspicion and early laparotomy reduced the morbidity and avoided mortality. This case report emphasizes the high index of suspicion for intra-abdominal injuries needed in penetrating abdominal injuries and the need for early exploration even if imaging and clinical status dictate otherwise.
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References
Stringel G, Talutis S, Alemayehu H, Guertin L. Severe unintentional penetrating abdominal injuries of domestic origin in children. J Pediatr Surg Case Rep. 2013;1(8):260-2.
Demetriades D, Hadjizacharia P, Constantinou C, Brown C, Inaba K, Rhee P, et al. Selective nonoperative management of penetrating abdominal solid organ injuries. Ann Surg. 2006;244(4):620-8.
Como JJ, Bokhari F, Chiu WC, Duane TM, Holevar MR, Tandoh MA, et al. Practice management guidelines for selective nonoperative management of penetrating abdominal trauma. J Trauma. 2010;68(3):721-33.
Siddharth BR, Keerthi MSS, Naidu SB, Venkanna M. Penetrating injuries to the abdomen: a single institutional experience with review of literature. Indian J Surg. 2017;79(3):196-200.
Arslan S, Okur MH, Arslan MS, Aydogdu B, Zeytun H, Basuguy E, et al. Management of gastrointestinal perforation from blunt and penetrating abdominal trauma in children: analysis of 96 patients. Pediatr Surg Int. 2016;32(11):1067-73.
Coppolino F, Gatta G, Di Grezia G, Reginelli A, Iacobellis F, Vallone G, et al. Gastrointestinal perforation: ultrasonographic diagnosis. Crit Ultrasound J. 2013;5(1):S4.
Weinberg JA, Croce MA. Penetrating Injuries to the 0Stomach, Duodenum, and Small Bowel. Curr Trauma Rep. 2015;1(2):107-12.
Cigdem MK, Onen A, Siga M, Otcu S. Selective nonoperative management of penetrating abdominal injuries in children. J Trauma. 2009;67(6):1284-6.
Matsevych OY, Koto MZ, Aldous C. Laparoscopic-assisted approach for penetrating abdominal trauma: A solution for multiple bowel injuries. Int J Surg Lond Eng. 2017;44:94-8.
Chestovich PJ, Browder TD, Morrissey SL, Fraser DR, Ingalls NK, Fildes JJ. Minimally invasive is maximally effective: diagnostic and therapeutic laparoscopy for penetrating abdominal injuries. J Trauma Acute Care Surg. 2015;78(6):1076-83.