Pediatrics & Therapeutics
Open Access
ISSN: 2161-0665
+44 1478 350008
ISSN: 2161-0665
+44 1478 350008
Shailesh Adhikary
BP Koirala Institute of Health Sciences, Nepal
Keynote: Pediatr Ther
Penetrating or perforating abdominal or chest injuries are very uncommon in the pediatric age group and are associated with a high mortality. Impalement injuries are consequence of penetration by elongated, usually fixed objects through the body. The case study begins with a 10-year young child suffered from a penetrating injury to the left iliac fossa, when he had fallen from a coconut tree on to the sharp bamboo fence. The bamboo stick penetrated the abdominal wall, perforated the jejunal loops at two sites along with the fundus of stomach, the left diaphragm, upper lobe of the left lung and the bevelled end of the bamboo had exited at the neck after tearing apart the neck muscles and skin sweeping along with it, few scattered pieces of jejunal tissues which were seen lying alongside. He was brought to the hospital 5 hours after the accident. On arrival he was in agony, dehydrated and scored 15/15 on Glasgow scale, remained hemodynamically stable, saturation of 93% with oxygen supplement. On examination a 75x5cm bamboo stick was in situ, which entered 4cm medial to the left anterior superior iliac spine and exited 3cm above the skin at the posterior triangle of neck. Operation imaging modalities were followed by exploration via the left thoracoabdominal incision. The thorax, mediastinum and neck were assessed in the beginning and after confirming that no great vessels were at risk, the foreign body was then carefully removed. The perforated stomach, jejunum and diaphragm were repaired. The upper lobe of lung had to be resected. An abdominal drain and two intercostal drains were placed. The total operative time was 3.30 hours and the child were managed in intensive care for 4 days and was finally discharged after two weeks. A rare penetrating injury with damage to the multiple organs could be managed successfully possibly because of a teamwork: and also, due to some sensible move by the villagers as they did not try to fiddle around with the foreign body.
Shailesh Adhikary is a Professor of GI and a Laparoscopic Surgeon currently serving as a Clinical Teacher at the Community Based Medical College in Eastern Nepal and has published 57 papers, columns at national and international journals and social news magazines and is also contributing as an Editorial Board Member for Asian Journal of Surgery. He is also the Governor of Endoscopic Laparoscopic Surgeons of Asia (ELSA) and is working to promote the Minimal Access Surgery across Nepal and in Asia.
E-mail: adhikaryshailesh@gmail.com