Blunt Polytrauma in Two Pediatric Patients: Surgical vs. Conservative Management – A Two-Case Study
Shaban Memeti¹, Haris Sulejmani², Marjan Kamiloski¹, Rexhep Selmani³, Qemal Rushiti³, Natalija Cokleska¹, Gani Ceku⁴, Defrim Kocinaj⁴
¹University Clinic of Pediatric Surgery, Skopje, North Macedonia; Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
²Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
³Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia; University Clinic for Digestive Surgery, Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
⁴Clinic of Pediatric Surgery, University Clinical Centre of Kosovo, Prishtina, Kosovo
Corresponding Author
Haris Sulejmani
Faculty of Medicine, Ss. Cyril and Methodius University in Skopje, North Macedonia
Email: [email protected]
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Abstract
Background: Pediatric blunt abdominal trauma presents complex diagnostic and therapeutic challenges. This case series highlights two pediatric patients with polytrauma from road traffic accidents, each with distinct intra-abdominal injuries and differing management strategies.
Case Presentation: Case 1 involved a 7-year-old female with pulmonary contusion, facial lacerations, splenic rupture, and bowel perforation. Case 2 involved a 13-year-old female presenting with macrohematuria and left flank pain after ejection from a vehicle; imaging revealed a Grade III/IV renal laceration with retroperitoneal hematoma and minor pleural effusion.
Intervention: Case 1 underwent emergency laparotomy with splenectomy and segmental bowel resection, followed by intensive monitoring and antimicrobial therapy. Case 2 was managed conservatively with intravenous fluids, antibiotics, and blood transfusion.
Outcome: Both patients recovered without major complications. Case 1 had a shorter hospital stay following definitive surgical control. Case 2 required prolonged observation due to the risk of delayed renal complications but achieved complete recovery.
Conclusions: Hemodynamically unstable patients with splenic rupture and bowel perforation require urgent surgery, while stable patients with high-grade renal injuries can be managed non-operatively, emphasizing individualized, stability-based care.
Keywords: pediatric trauma, blunt abdominal injury, polytrauma, splenic rupture, non-operative management, emergency surgery