Small bowel entrapment and ureteropelvic junction disruption associated with L3 Chance fracture-dislocation

Abstract

Paediatric Chance fracture are rare lesions but often associated with abdominal injuries. We herein present the case of a seven years old patient who sustained an entrapment of small bowel and an ureteropelvic disruption associated with a Chance fracture and spine dislocation following a traffic accident. Initial X-rays and computed tomographic (CT) scan showed a Chance fracture with dislocation of L3 vertebra, with an incarceration of a small bowel loop in the spinal canal and a complete section of the left lumbar ureter. Paraplegia was noticed on the initial neurological examination. A posterior L2-L4 osteosynthesis was performed firstly. In a second time she underwent a sus umbilical laparotomy to release the incarcerated jejunum loop in the spinal canal. An end-to-end anastomosis was performed on a JJ probe to suture the left injured ureter. One month after the traumatism, she started to complain of severe headaches related to a leakage of cerebrospinalis fluid. Three months after the traumatism there was a clear regression of the leakage. One year after the trauma, an anterior intervertebral fusion was done. At final follow-up, no neurologic recovery was noticed. In case of Chance fracture, all physicians should think about abdominal injuries even if the patient is asymptomatic. Initial abdominal CT scan and magnetic resonance imaging provide in such case crucial info for management of the spine and the associated lesions.

Fracture and dislocation of lumbar vertebrae with entrapment of small bowel: A case report and literature review

“…2,5,10,13 Three reports described two cases of injury that showed collection of air in the spinal canal on CT scanning; 5,13 and one case of herniation of the small bowel loop into the spinal canal was confirmed by magnetic resonance imaging (MRI). 11 Seven cases had positive laparotomy findings, obtained on the basis of diagnostic peritoneal lavage, 7,8 barium meal 4,6,7,10 and sonography. 12…”

“…Only 12 cases from seven countries with detailed clinical information were reported between 1979 and 2016 (Table 1). 2,4–14 The mean age of the patients was 24.2 years. Among the patients, six were children, of whom the youngest was 3 weeks old.…”

“…2,4–14 The authors of one study thought that posterior arthrodesis should be performed first to avoid iatrogenic nerve injuries while mobilizing the patient. 11 However, this approach may reduce the ability of lumbar hyperextension and make the resetting of the incarcerated bowel difficult. Considering this situation and the risk of infection, the laparotomy was performed before reduction and stabilization of the spine in the current case.…”

“…2,4–14 Pneumonia and left femoral vein thrombosis occurred in one patient; 7 Candida albicans infection and cortical infarcts in the distribution of the right middle cerebral artery occurred in one patient; 13 laparotomy wound infection occurred in one patient; 4 pulmonary embolism occurred in one patient; 8 retroperitoneal abscess on the tenth postoperative day occurred in one patient; 12 and one patient experienced a cerebrospinal fluid leak. 11 Five of 12 patients had different degrees of nerve injury. 4,7,8,11,12 None of the 12 patients died as a result of their injuries.…”

“…11 Five of 12 patients had different degrees of nerve injury. 4,7,8,11,12 None of the 12 patients died as a result of their injuries.…”