KIMSHEALTH doctors save cricketing boy’s life-threatening abdominal injury

Thiruvananthapuram / October 16, 2021

Doctors at KIMSHEALTH performed a critical surgery on a youth who suffered a life-threatening abdominal injury after a sharp object pierced through his anus while playing cricket and lodged a foreign body inside the urinary bladder.

The operation by six experts was critical since the 19 -year-old also suffered from a congenital anomaly of the intestines. The youngster, on the cricket ground, was trying to take a catch when he landed on a wooden stub that entered the bottom of his rectum, according to doctors.

“Post-operatively, the patient has recovered well,” said Prof. Sanoop K. Zachariah, Senior Consultant, General and Minimal Access Surgery at KIMSHEALTH. “He is asymptomatic on the third month of follow-up.”

The youngster’s abdomen had torn when he met with the accident. He managed to get up soon and, despite a mild pain around the anus, went on to resume routine.

Even as the youth continued to take food and pass urine as well as stool normally, he checked in at a nearby hospital. An ultrasound scan revealed a strange object in his urinary bladder, leading the patient to be brought to KIMSHEALTH for advanced evaluation.

By then the pain had vanished, with only a small wound left inside his anus. The doctors ordered a CT scan, which showed a long slender foreign body inside his abdomen within the urinary bladder. While the lower half of this object was lying in a highly vascular area of the prostatic plexus, while its upper half was in the bladder. The scan, further, revealed the boy had Left Paraduodenal Internal Hernia, which indicated a congenital anomaly of the intestines.

“It was strange the patient showed no symptoms of danger and even escaped serious bleeding,” Prof .Zachariah said. “The object had not only just pierced his anus; it even passed through both the soft tissues in his pelvis and prostatic plexus before getting into the abdomen and rupturing the urinary bladder.”

The dicey situation complicated the strategy about surgery. The lower part of the foreign body had lodged in the prostatic vascular plexus, and disturbing it could lead to severe bleeding. “Surgical access to this area is difficult,” Prof Zachariah pointed out. “Also, it was uncertain if the rectum was injured. If so, it would be necessary to bring his intestines out temporarily as a diversion stoma to prevent leakage of faecal matter.”

With multiple options in mind, the team of doctors proceeded with the surgery. They cut open the urinary bladder and found a piece of wood lying in it. The stick was meticulously removed, avoiding bleeding injury to surrounding tissues and prostatic plexus.

To ascertain the gravity of the rectal injury, doctors traced the path of the foreign body. They rail-roaded a urinary catheter from the point of entry in the anus and brought it out through the abdomen and bladder. Methylene blue dye was passed through the catheter  to check for any leak into the rectum. An on-table sigmoidoscopy was also done to look for any rectal injuries.

A brief wait ensured there was no leak into the rectum, prompting the doctors to avoid a stoma. A thorough check revealed no other abdominal injuries in the abdomen, following which the team focused on repairing the paraduodenal hernia. This is a rare type of congenital hernia formed to due abnormal development and defective rotation of the intestines in the faecal stage; it can lead to serious complications later in life.

The paraduodenal hernia was successfully repaired. The abdomen was closed over a suprapubic catheter.

The team, besides Prof.  Sanoop K. Zachariah, comprised Urologist Dr Sudin S.R., Surgical Gastroenterologist Dr Varghese Yeldho, Medical Gastroenterologist Dr Madhu Sasidharan and Anaesthetist Dr Hashir A.