Delayed return of urinary continence following the removal of neglected sacral shrapnel

Abstract

BackgroundGlobalisation of terrorism has led to an increase in the number of injuries from the explosion of improvised explosive devices, with complications resulting from the retained shrapnel. It had been found that a third of those who sustained penetrating spinal cord injuries are from explosions. Retained foreign body in the sacral canal segment is rare, especially shrapnel presenting with urinary incontinence. Moreover, the one who had a dramatic recovery of urinary continence following removal of neglected sacral canal shrapnel. We report a case of a delayed improvement (recovery) in urinary continence following removal of neglected sacral canal shrapnel remotely aided by a pelvic floor exercise.Case presentationOur patient was a 14-year-old male who presented with a 3-year history of trauma to the lower back from an Improvised Explosive Device. He was initially associated with difficulty in walking that improved over eight months. However, the urinary incontinence persisted. He was found to be preserved with no neurological deficit in the lower limb. There was a lower back, midline wound, discharging pus. Lumbosacral imaging revealed a sacral (S2) canal Shrapnel. As a case of urinary incontinence from sacral shrapnel, he had the removal of the shrapnel, did well postoperatively, commenced on pelvic floor exercise. He became continence of urine over time.ConclusionsRetained foreign bodies in the spinal canal are associated with complications that include neurological deficit. Neglected (long-standing) sacral shrapnel with urinary incontinence is rare; moreover, the recovery of the continence with the removal of the shrapnel is aided by the commencement of pelvic floor exercise.