A 9-year-old girl, waken up from sleep with acute abdomen. Noted by care-taker, evisceration of small bowels from a stab wound at the epigastric region. She was brought to ED with class II shock and mild pallor. Her caretaker lodged a police report after noticed her schizophrenic uncle left home with a knife. Following adequate resuscitation, she had emergency laparotomy. A moderate gastric content contamination with multiple sites of perforation at the stomach, small bowels and its mesentery was seen and repaired primarily. Postoperatively, she was ventilated in ICU, provided with parenteral nutrition and institution of broad-spectrum antibiotics. She was extubated and transferred to HDW on day 4 and make a complete recovery on day 10.Discussion:Paediatric penetrating abdominal injury is much less common as compared to blunt abdominal injury. It is important to determine the mechanism of injury as it influences the management decision. The colon and small bowels are the most commonly injured hollow organs in penetrating injury. A bowel injury in trauma isa leading cause of morbidity and mortality. Managing postoperative bowel injury in paediatric required a multidisciplinary team approach for a successful outcome. A well-prepared surgical team with a well-equipped operation room, availability of blood substitutes and the necessary investigations are all the important links in the management of the patient of bowel evisceration.
An 11-year-old boy tried to jump over a metal rod but landed on it presented with perianal pain and rectal bleeding. On examination, there is a 1.5cm perineal laceration. His blood results showed a normal TWC with a normal abdominal and chest radiographs. His vital signs were within normal limits. He was planned for bedside T&S by ED team but deferred as persistent blood oozing from rectal, thus referred to Paediatric Surgery. Upon review, there was 2x1cm perianal laceration at 7 o’clock, abrasion wound at 10 & 12 o’clock. Ultrasound showed no free fluid. He was taken to emergency OT for EUA, intraoperative findings were a perianal laceration, on table sigmoidoscopy showed posterior rectal wall irregularities with slow oozing blood from it, however, no obvious perforation seen. The patient developed fever with lower abdominal tenderness on the following day. Urgent CECT abdomen pelvis performed and showed features of extraperitoneal rectal perforation. He was treated conservatively with antibiotics and NBM with parenteral nutrition support. He made a good recovery and was discharged home on day 9.Pediatric perineal impalement injuries often caused by falls on an offending object. These children are prone to severe injuries as compared to adults and the lesions in the pediatric perineum may appear innocuous, but can be potentially life-threatening and surgically challenging. Perineal impalement injuries in children are classified as transanal or perineal and further subdivided as extraperitoneal or intraperitoneal. This classification method is used to predict potential injuries and develop treatment guidelines. Evaluation of perineal impalement injuries in children needs to be thorough even in the presence of minimal or no symptoms.