Small bowel entrapment and ureteropelvic junction disruption associated with L3 Chance fracture-dislocation.
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.
Sebastien Pesenti, Emilie Peltier, Franck Launay, Jean-Luc Jouve, Pediatric Orthopaedics, Hopital d'Enfants de la Timone, Aix Marseille University, 13005 Marseille, France.
Sebastien
S
Pesenti
Sebastien Pesenti, Emilie Peltier, Franck Launay, Jean-Luc Jouve, Pediatric Orthopaedics, Hopital d'Enfants de la Timone, Aix Marseille University, 13005 Marseille, France.
Benjamin
B
Blondel
Sebastien Pesenti, Emilie Peltier, Franck Launay, Jean-Luc Jouve, Pediatric Orthopaedics, Hopital d'Enfants de la Timone, Aix Marseille University, 13005 Marseille, France.
Alice
A
Faure
Sebastien Pesenti, Emilie Peltier, Franck Launay, Jean-Luc Jouve, Pediatric Orthopaedics, Hopital d'Enfants de la Timone, Aix Marseille University, 13005 Marseille, France.
Emilie
E
Peltier
Sebastien Pesenti, Emilie Peltier, Franck Launay, Jean-Luc Jouve, Pediatric Orthopaedics, Hopital d'Enfants de la Timone, Aix Marseille University, 13005 Marseille, France.
Franck
F
Launay
Sebastien Pesenti, Emilie Peltier, Franck Launay, Jean-Luc Jouve, Pediatric Orthopaedics, Hopital d'Enfants de la Timone, Aix Marseille University, 13005 Marseille, France.
Jean-Luc
JL
Jouve
Chance fracture; Dural tear; Seatbelt; Small bowel injuries; Uretero-pelvic disruption
Neurosurg Focus. 2000 Jul 15;9(1):e1
16859263
J Pediatr Orthop. 1991 Nov-Dec;11(6):783-5
1960207
J Trauma. 1996 Sep;41(3):476-83
8810966
J Paediatr Child Health. 2000 Jun;36(3):265-9
10849230
J Pediatr Surg. 1993 Jul;28(7):915-9
8229568
J Trauma. 2000 Nov;49(5):958-9
11086794
Am J Surg. 1989 May;157(5):457-8
2712201
J Orthop Surg (Hong Kong). 2007 Aug;15(2):248-50
17709873
J Bone Joint Surg Br. 1982;64(5):520-5
7142258
Ann Surg. 1993 Mar;217(3):272-6
8452405
J Urol. 1981 Jan;125(1):108-11
7463564
Injury. 1996 Oct;27(8):596-8
8994570
Am J Emerg Med. 2015 Jun;33(6):861.e1-3
25595271
Can J Surg. 1985 Mar;28(2):138-40
3971239
Am Surg. 1997 Mar;63(3):294-8
9036903
J Pediatr Surg. 2001 May;36(5):760-2
11329583
Ann Surg. 2004 Jan;239(1):127-31
14685110
J Trauma. 1980 Nov;20(11):996-8
7431460
J Trauma. 1990 Apr;30(4):384-91
2325168
AJR Am J Roentgenol. 1988 May;150(5):1129-30
3258716
J Trauma. 1993 Dec;35(6):960-1
8264001
Spine (Phila Pa 1976). 2007 Nov 15;32(24):E702-7
18007230