Multiple Foreign Bodies in a 5-Year Old: Non-Accidental Trauma

Foreign bodies, a significant proportion of which are a result of non-accidental trauma, are common but under-reported. Pediatric foreign body injuries can be inconsequential, severe or even fatal, and cause long-lasting morbidity and the need for treatment and hospitalization. Evaluation of injury or death requires elements of detection, pattern recognition, interpretation and comparison, all based on clinical, radiological and forensic experience with normal and abnormal findings. We report an unusual and strange case of non-accidental trauma in a young child who presented to our surgical services with 44 sewing needles and wires in his body. The patient had specific characteristics or risks for abuse. His injuries were evaluated, recognized, documented and reported. He was treated for peritonitis and malnutrition and the foreign bodies removed using staged operations under image guidance. Patient’s recovery was uneventful. Keywords: Multiple foreign bodies, Traum

Surgical management of typhoid ileum perforations: a systematic review

Background: Typhoid is a disease caused by a gram negative bacterium Salmonella typhi. Prolonged infection leads to necrosis in the Peyer's patches of the antimesenteric border of bowel leading to intestinal perforation. Various surgical procedures have been described for the treatment of these perforations. Typhoid intestinal perforations are still associated with high case fatality rates averaging 15.4%. Objective: To identify current surgical management options for typhoid ileal perforations and to describe the best surgical management in relation to mortality and complications. Methods: A systematic review was done using PRISMA guidelines. Common search terms used were typhoid perforation/typhoid ileal perforation management. A narrative synthesis of the findings from the included studies structured around the type of intervention, target population characteristics, types of outcome and intervention content was done. Results: Primary closure of ileal perforations was the most commonly performed procedure. Ileostomy is the choice of surgery for severe abdominal contamination and when the patient has poor general health. Most studies found mortalities and complications to be unrelated to surgical procedure done. Mortality was significantly associated with the number of perforations and abdominal contamination. Conclusions: Individual studies support particular surgical interventions but the review showed that complications and mortality are not related to the type of surgical intervention alone but to a number of other non-surgical factors. There is need for further level 1 studies on this topic

Evolution of spontaneous dissecting mycotic Superior Mesenteric aneurysm in a 12-year-old child: A case report

Visceral artery aneurysms are uncommon especially in children. One of the main complications before surgery is rupture. This 12-year-old child presented with a large, fast growing, mycotic superior mesenteric aneurysm that had all the favourable conditions for rupture. There was spontaneous dissection of the weakened media with partial erosion of the aneurysm into the wall of the third part of the duodenum. However, this aneurysm formed a thrombus that gradually occluded the lumen. This led to formation of collateral vessels for the continued vascular supply of the midgut. The uniqueness of this case report has been highlighted from several points (the rarity of the condition in children, the favorability of the conditions to rupture, the gradual but complete luminal occlusion with the eventual formation of collaterals to supply the midgut, and the spontaneous medial dissection with partial duodenal wall erosion without causing rupture). Although there is no standard surgical approach, early elective surgery is recommended. Nonoperative  approach is an option that should aim at reducing the risk for rupture. Control of blood pressure is key. This child underwent surgery. Under total vascular exclusion, the aneurysm was opened. After total luminal occlusion and collateral blood supply to midgut was noted, infected thrombus was evacuated and the aneurysm walls debrided. Keywords: Superior mesenteric artery, visceral artery aneurysm, aneurysm, midgut

Diagnostic Imaging of Non-Accidental Injury and Percutaneous Foreign Bodies: A Case Report from Zambia

This case report presents the role imagingplayed in the diagnosis and surgical removal of multiple percutaneous foreign bodies in a  5-year-old child who presented with non-accidental injuries (NAI) to medical facilities in Zambia. Children are commonly referred for imaging with suspected accidental foreign bodies, but percutaneous foreign bodies due to NAI are rare. NAI is caused due to child physical abuse and therefore, imaging plays a major role in the diagnosis and provision of legal evidence. In this case report, conventional radiography (plain film) of askeletal survey was the first imaging requested. This was supplemented with a computed tomography (CT) scan of the thorax and abdomen. Lastly, foreign bodies were removed under the guidance of the image intensifier. Although, the cases of NAI reported and presented in medical facilities in Zambia are rare, this case shows that physical child abuse is practiced in our communities. Thus, radiographers and radiologists should pay attention to such cases during imaging and reporting, respectively