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CASE
SUMMARY
A patient Master Shadman, 12
years of age presented in emergency dept. with a history of fall from his
roof (20 feet) upon a projecting surface. At the time of presentation he
was in a state of shock with injuries at the site of pelvis & perineum.
Emergency treatment was
performed as follows under G/A:
Exploratory
Laparotomy
Exploration
of pesineal wound
Findings were:
Hemoperitoneum
Rupture
of urinery bladder
Lacerations
and multiple perforations in lower rectum
Complete
rupture of urthra
Damage
of anal sphineter
Lacerated
wound of perineum was communicating with peritoneal cavity, rectum and
urinery bladder
For the above inuries
following treatment was given:
1.
Removal of blood from peritoneal cavity.
2.
Explocation of all abdominal viscera for assessment of injuries.
3.
Proximal Sigmoid colostomy for fecal diversion.
4.
Rail road technique for restoration of continuity of urethra.
5.
Repair of wall of urinery bladder and supra-pubic cystostomy.
Orthopaedic
Problems:
Revealed
on x-ray and clinical examination were:
1.
Sub-trochanteric fracture of right femur.
2.
Fracture of Ischiopubc ramus of pelvis (rt.side)
3.
Fracture of iliopubic ramus (lt.side)
Management
of fractures were done by the advice of orthopaedic surgeon (Ortho Unit-I)
Post-Operative
Condition:
Recovery
was slow and satisfactory
Present
Problems:
1.
Sigmoidostomy which needs closure after the repair of anal canal and rectum
(sphineter)
2.
Urethral stricture (post traumatic) needs urethroplasty.
Note:
In
management of above patient following surgeons were involved:
1.
Surgeons from Surgical Unit I, Civil Hospital, Karachi
2.
Urologist from SIUT, Civil Hospital, Karachi.
3.
Orthopaedics from Orthopaedic Unit I, Civil Hospital Karachi. |
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