![]() ![]() The image on the right corresponds to the post-emboliza tion angiography: proximal embolization in the splenic hilum using microcoils (c), preserving irrigation of the upper third of the spleen. The image on the left is the first control: Injec tion in the celiac trunk (arrow) and splenic artery (a) showing sinusoidal impregnation of the spleen with alteration of the vascularization of the middle and lower third (b) consistent with splenic rupture, without evidence of focal arterial bleeding. ![]() Due to the presence of active bleeding, splenic embolization was performed by angiography without incidents ( Figure 5).įigure 5 Angiography. The splenic lesion was classified as IV-A AAST 9. Spinal injury was ruled out and coronal imaging showed splenic rupture with multiple lacerations and signs suggesting active arterial bleeding, without hilar liver laceration associated to laceration of the pancreas tail with pre sence of small anterior and posterior peripancreatic fluid collections, perisplenic free fluid in the pelvis and ascites ( Figure 4). CT scan of the cervical spine, tho rax, abdomen, and pelvis was performed. In the ER, initial resuscitation was started with the administration of fluid bolus volume, which normali zed the heart rate (83 bpm), and intravenous analgesia was administered. Diffuse abdominal tenderness, which was increased in the left hypochondrium, associated with muscle rigidity and Blumberg sign. He reported slight pain on cer vical palpation. He presented super ficial abrasion on the right shoulder and the left hypo- chondrium and thigh. On physical examination, he was pale, well-hydrated, and perfused. He presented with tachycardia (128 bpm), nor mal BP, 15 points in the GCS, and was immobilized with a cervical collar. Healthy 14-year-old male patient went to the emer gency room 60 minutes after falling from his bike hit ting the left thoracoabdominal region with the handle bars. The objective of this work is to describe three clinical cases of blunt abdominal trauma in children caused by bicycle handlebars and to describe different types of observable injuries, with their forms of presentation and respective manage ment. There are no scientific publications in our coun try that address this type of accident and presentation in the pediatric population, despite its high frequency and potential seriousness. The use of ima ging, such as CT scan, has allowed identifying the lo cation of the lesions, and help to determine their seve rity, providing elements to define the best therapeutic alternative. However, the high associated morbidity has favored conservative management, which has proven to have better short- and long-term results 6. Traditionally, the finding of free fluid or solid or gan injury has been managed with emergency surgery 8. Their magnitude is measured according to the scale of the American Association for the Surgery of Trauma (AAST), which is based on an anatomical description and goes from I (the least serious lesions) to V (the most serious ones) ( 9. Among the solid organ lesions, the most frequent are the hepatic, splenic, pancreatic, and renal ones 7. Hollow viscus injuries may include per foration or hematoma along the gastrointestinal tract and its mesentery. In the abdominal region, the most frequently affected 7, 8, injuries of hollow viscera and solid organs are described. There are diverse types of injuries caused by these accidents. In a child’s body, forces are more easily transfe rred through the abdominal wall and there is a greater relative surface area of solid organs such as the spleen and liver 2. When faced with a direct hit to the abdominal area, a pediatric patient is at higher risk of suffering internal organ injuries compared with an adult patient 2. However, injuries to intra-abdominal organs are still frequent 6.īicycle accidents can cause damage by two mecha nisms, fall from it, associated with head trauma, or a blow with one of its parts, most commonly the handlebars 7. The prevention of serious injuries associa ted with this type of accident has focused on the use of helmets, thus reducing the incidence of brain injury 2, 4. According to our country’s records, during 2016, of all those injured due to traffic accidents involving cyclists, which were 3,326, 14% were children under 18 years of age (489 injured) ( 5. Bicycle accidents account for a significant proportion of all trauma in children 2 - 4. In Chile, during 2017, 40.1% of deaths between the ages of 1 and 19 were secondary to trauma 1. Trauma is a major cause of morbidity and mor tality in pediatrics.
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