Controlled surgical removal of an impaled foreign body in pediatric anogenital–lumbosacral penetrating trauma: a case report
Adam Moeljono, Dimas Haryo Yudoyono, Natalia Susanti, Raja Argha Sohasuhatan SiregarIntroduction:
Perineal impalement injuries are rare but potentially life-threatening, often associated with complex trajectories and a high risk of hemorrhagic and septic complications. The absence of standardized management strategies highlights the importance of adhering to fundamental trauma principles.
Case presentation:
We report a 7-year-old girl with a transpelvic impalement injury caused by a rusted iron rod. The primary survey and preoperative clinical and radiological assessments demonstrated hemodynamic stability and revealed no neurological, genitourinary, or intra-abdominal injury. Controlled multidisciplinary surgical extraction under direct visualization was performed with repair of an associated rectal perforation and creation of a diverting sigmoidostomy. The patient had complete wound healing, normal ambulation, and intact bowel and bladder function with no neurological deficits at the 4-month follow-up.
Discussion:
When managing transpelvic impalement injuries, we assess whether there are complications such as neurological, genitourinary, and abdominal visceral injuries. To rule these out, we must not rely solely on radiological findings but must also consider physical examination and intraoperative findings. Furthermore, the presence of tamponade indicates that we should not perform blind extraction. A multidisciplinary, controlled extraction under direct visualization is the safest option to minimize complications.
Conclusion:
Controlled extraction after careful clinical and radiological evaluation can lead to good results in complex pediatric perineal impalement injuries.