Hemorrhagic Shock Caused by Mesenteric Injury - Ski Pediatric Blunt Abdominal Trauma case report

K Karavdić,D Anić,N Begić,S Begić,A Firdus,L Kapetanović-Zametica,N Kulenović-Spahović

doi:10.31579/2768-2757/040

Abstract

Trauma is the leading cause of pediatric mortality and abdominal injury is a significant contributor to morbidity. Abdominal trauma in the population of injured children, is the third leading cause of death in this population, after head and thoracic injuries. It is the most common cause of death owing to unrecognized injury. They most often occur in traffic accidents, games and sports. The clinical presentation depends on the severity of the injury, the injured organ and the associated injuries. Mesenteric injury from blunt abdominal trauma is uncommon and can be difficult to diagnose. It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. We present an unusual case, a seven-year-old boy who was injured while skiing. The patient was in a state of hemorrhagic shock and underwent emergency surgery after an urgent diagnosis. During the operation, the leading trauma and the reason for the hemorrhagic shock were found to be a mesenteric injury, and bleeding from the branches of the superior mesenteric artery. Early transport, monitoring and diagnostics significantly contribute to reducing morbidity and mortality. The standard in surgery is non-operative treatment of injured parenchymal organs. A multidisciplinary approach that includes doctors of various specialties (pediatric surgeons, pediatricians, neurosurgeons, anesthesiologists and radiologists) who contribute to the diagnosis and treatment of injured children through diagnostic and therapeutic procedures has a key role. At the end, the decision regarding surgical treatment is responsibility of pediatric surgeon.

Highlights

Intraabdominal injuries occur as a result of blunt abdominal trauma or penetrating trauma and it is the most common cause (85%), while penetrating trauma is present in a minority of cases (15%)
Despite the frequency with which abdominal trauma occurs in children, there is still controversy over the optimal evaluation strategy to identify intra-abdominal injury.Assessment by the American Association for the Surgery of Trauma Surgery (AAST) is most commonly used to classify spleen, liver, and kidney injuries
The first is that, generally, due to the anatomy, injuries in children tend to cause more organ damage and be more severe for the following reasons: 1) a small external force can cause severe injuries because the supportive tissues around the ribs, abdominal muscles, and organs are weak; 2) the relative capacities of solid organs such as the liver, pancreas, and spleen are large; and 3) the solid organs are not protected by the ribs because the diaphragm is almost horizontal [9-11] Other characteristics include the following: 1) since a small force is focused on a particular point, organ damage is often more severe than expected; and 2) compression between the abdominal wall and vertebral body by an external force often results in more severe organ damage

Summary

Cl AUCTORES inical Surgery and Research

Journal of Clinical Surgery andCopy Research rights@ K Karavdić et al. Hemorrhagic Shock Caused by Mesenteric Injury - Ski Pediatric Blunt Abdominal Trauma case report. Journal of Clinical Surgery and Research. 3(3); DOI:10.31579/2768-2757/040

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Clinical Surgery and Research

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