Neonatology and Perinatology

Biography

Shailesh Adhikary qualified as a Surgeon from Post Graduate Institute in Chandigarh, India in 1994 and currently working as a Clinical Teacher and a Surgeon at the Community Based Medical College in Eastern Nepal for 12 years and has published 34 papers at national and international journals and is serving as an Editorial Board Member for Asian Journal of Surgery. He is also the Governor of Endoscopic Laparoscopic Surgeons of Asia working to promote the Minimal Access Surgery Development across Nepal and in Asia.

Abstract

Introduction: Penetrating or perforating abdominal or chest injuries are very uncommon in the paediatric age group and are associated with a high mortality. Impalement injuries are consequence of penetration by elongated, usually fixed objects through the body.

Case Summary: A 10-year young child suffered from a penetrating injury to the left iliac fossa when he had fallen down 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 five hours after the accident. On arrival he was in agony, dehydrated and scored 15/15 on Glasgow scale, remained haemodynamically stable, saturation of 93% with oxygen supplement. On examination a 75x5 cm bamboo stick was in situ, which entered 4 cm medial to the left anterior superior iliac spine and exited 3 cm 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 was managed in intensive care for four days and was finally discharged after two weeks.

Conclusion: A rare penetrating injury with damage to the multiple organs could be managed successfully possibly because of teamwork and also due to some sensible move by the villagers as they did not try to fiddle around with the foreign body.