Bladder Avulsion Due To Child Abuse, Report of a case and review of articles

Blunt injuries are more common in children than penetrating injuries by a ratio of 12: 1. In recent years the number of penetrating trauma is increasing. Although blunt injuries are more common, penetrating injuries are more lethal. Trauma in children is one of the top three causes of death in the American youth. The majority of blunt trauma in children is sustained unintentionally, but between 5–10% of serious injuries are due to intentional physical assault (of which half are due to physical abuse). The incidence of physical abuse to children is estimated to be 4.9 per 1,000. Of those abused, 1 of every 1,000 will ultimately die as a result. Lower genitourinary system is vulnerable to child abuse usually in the form of sexual abuse. Although severe life-threatening bladder trauma during physical abuse is rare, it may happen, especially after lower abdominal blunt trauma. Here we present a case of total avulsion of the bladder body from trigon in a 3-year-old boy following child abuse who was admitted in the emergency department of Dr. Sheikh pediatric hospital in profound shock. In exploratory celiotomy the bladder was avulsed just proximal to trigonal area. Primary repair of bladder and diverting cystostomy was performed. Post-operative course was uneventful. Patients discharged after 5 days in good condition. Unfortunately he was admitted to PICU again after one month due to head trauma and right humerus bone (child abuse) fracture