Penetrating Chest Trauma in a Child Caused by a Fall on a Metallic Bar: A Case Report.

Penetrating chest trauma in children is an uncommon condition. Patients may be asymptomatic or in a critical state. Visceral and vascular damage are frequently present when penetrating objects enter the thoracic cavity. Although many studies have discussed penetrating thoracic trauma in adults, very few deal with the pediatric population. Here, we present the case of a 13-year-old child with an intrathoracic metallic bar after penetrating chest trauma. The clinical examination showed a stable patient with a palpable bar and subcutaneous emphysema in the left axillary area. The radiological scan did not reveal any vital damage. The bar was removed through the entry wound without thoracotomy or thoracoscopy. The patient evolved without any incident and was discharged after three days. Good improvement was noted over three months of follow-up. Intrathoracic foreign bodies secondary to penetrating trauma are rare in children. An exhaustive imaging examination is required to identify the precise location of the foreign material and find any severe organ or vascular injuries. If the condition permits, direct removal should be attempted in an operating room, in case surgical intervention is needed after the extraction.

[Spontaneous rupture of the spleen in a child]. / Rupture spontanée de la rate chez un enfant.

Non traumatic or spontaneous splenic ruptures are rare but potentially fatal. Mortality is mainly due to delayed and therapeutic diagnosis as well as to the risks associated with a predisposed condition and with the severity of underlying pathologies. Splenectomy is necessary in the majority of cases. They can occur either in subject with macroscopically healthy spleen but, for instance, with infectious mononucleosis (IMN) or malaria or in subjects with pathologic spleen due to tumor, for example, but even in patients with some coagulopathies. We here report the case of a 6 year old child followed up for coagulopathy, admitted with diffuse violent abdominal pain, cutaneous-mucous paleness with hemodynamic stability. Laboratory tests showed macrocytic normochromic anemia; the diagnosis of splenic rupture was based on ultrasound and abdominal CT scan. Because the patient was hemodynamically stable, conservative treatment with 2 packed red blood cell transfusions was proposed. Patient's outcome was favorable.