1. Barbara Popek, Joanna Pietrzyk
A rare case of a foreign body in the urinary bladder as a remnant of traumatic perforation of the rectum and urinary bladder.
Students' Scientific Group "Pediatric Surgery",    Department of Pediatric Surgery and Oncology, Medical University of Lodz
Clinic Manager: Prof. Andrzejewska Ewa, PhD
Tutors: Z. Jankowski, M.D., J. Jabłoński M.D., M. Lewandowska M.D.

2. Pediatric impalement injuries are:
uncommon (the risk of overlooking!)
the result of accidental falls or sexual abuse

3. Casuistic case reports of combined perforation of the rectum and bladder in the literature:
Johnson P A. Br Med. J. 1971; 2 (5764):
9-year old girl with penetrating trauma resulting in perforation
of the rectum, bladder and vagina
Bysiek A. with co- authors Rocznik Dziecięcej Chirurgii Urazowej.
9 (XXXI):
7-year-old boy with post-traumatic infraperitoneal perforation
of the rectum and bladder
Kim S with co- authors, J. Pediatr Surg. 2006; 41(9):E1-3.
12- years old boy with post-traumatic perforation of the rectum
and bladder
Guha P with co- authors J. Pediatr Urol. 2011; XX: 1-3.
6-year old boy with post-traumatic perforation of the rectum

4. Pediatric impalement injuries:
Children may be predisposed to severe injuries:
Less awareness of the risks and consequences of injury
Anatomical differences:
- Urogenital septum lies more superficial
- Bladder, uterus and rectum lie low in pelvis
- In girls rectovaginal septum is thinner

5. Pediatric impalement injuries:
Careful critical history and phisical examination
The absence of external physical findings does not exclude intraabdominal pathology.

6. https://poradnikinwestycyjny.wordpress.com/tag/cel/
Aim of the study:
   analyse of case of a foreign body
in urinary bladder as a remnant of traumatic perforation of the rectum and bladder
in 15 -year old boy.

7. Case report (The 15 -year old boy):
Hospitalization in regional hospital:
First hospitalization (patient was intoxicated):
maltreatment (burnsI/II, trauma to lumbar regio and shoulder joint)
laboratory tests and x-ray without deviation
discharge from hospital with a recommendation
for further outpatient care

8. Case report: Second hospitalization in regional hospital:
fever and abdominal pain
infection of urinary tract
erytrocyturia
gastritis

9. Case report: Transfer to Clinic of Pediatric Surgery and Oncology:
due to estalation of symptoms
diagnostic imaging (usg, rtg, CT):
- free fluid in the area of the spleen and between bowels
- air under the diaphragm and in bladder

10. Case report:
perforation of the rectum, sigmoid colon and urinary bladder (of ~1 cm)
Laparotomy
evacuation of abscesses around the bowels and a large amount of purulent-fecal content
colostomy and drainage into the peritoneal cavity
Closure of colostomy in the next stage of treatment
Repeated treatment due to infections of the urinary
tract

11. Case report: recurrent infections of the urinary tract
suspicion of bipartite bladder or diverticulitis of the bladder (cystography, urography)
uroCT

12. uroCT

13. The foreign body removed from the bladder:

14. Conclusions:
1.Lack of possibility of collecting information about nature of the trauma may cause delay in evaluation of the severity of injuries of the perineum.
2. Infections of the urinary tract after injury of the perineum are an indication for further diagnostics to clarify the cause.
3. There exists need for further educating physicians about necessity to direct patients after trauma to the area of the perineum to surgical consultation.

15. Thank you for your attention