Primary Reconstruction of Bladder Neck Transection and Vaginal Laceration Post Blunt Abdominal Injury a Case Report

Abstract

Blunt abdominal injury is not uncommon in the paediatric population. The presentation can be immediate or delayed, and if not promptly recognized may be attended with complications such as septicaemia, shock or death. Simple, readily available and cheap imaging techniques such as abdominal radiograph and ultrasound scan still remain relevant in the diagnosis of blunt abdominal injuries where abdominal computerized tomography is unavailable or unaffordable. This can expedite the decision for an early surgical exploration. In girls, complete bladder neck transection with vaginal wall injury is a rarely reported and unusual association of blunt abdominal injury more so with delayed presentation in the absence of an associated pelvic fracture. This rare trauma entity in a child can pose a diagnostic difficulty leading to delayed presentation. This is a case of 3 year old girl with 3 weeks history of trauma to the abdomen from collapsed building fence during a heavy downpour. She later developed progressive abdominal distension with pain, constipation, vomiting, fever and drainage of clear fluid per vaginam. She had visited several hospitals but was managed non-operatively. Over the period the patient had some relief of symptoms until she presented to our facility with poorly defined features of peritonitis following a referral from a peripheral hospital. Abdominal ultrasound scan revealed intraperitoneal fluid collection. She was resuscitated and had exploratory laparotomy with primary reconstruction of the bladder neck transection and vaginal wall laceration. She did well immediate postoperative except for the superficial surgical site infection and during follow-up visits. Primary repair of traumatic bladder neck transection and vaginal wall laceration in paediatric patients with delayed presentation of blunt abdominal injury is a feasible option of management. However, long term follow up is recommended as secondary procedures may become necessary.