Ureteric Transection with Jejunal Injury Secondary to Bicycle Handle Bar Penetrating Injury in a 13 Year Old Boy

Abstract

Background: Ureteric trauma is rare, occurring in <1% of all traumas. Bicycle handlebar injury is a unique trauma mechanism especially noticed in childhood. Case Presentation: We present a unique case of a 13-year-old male who sustained a penetrating abdominal injury from a bicycle handlebar. Upon initial examination there was herniation of bowel through the abdominal wound, so exploratory laparotomy was performed. There was  transection of the jejunum at a distance of 10 cm from the duodeno-jejunal flexure with more than 75 % of the circumference     of the jejunum and there was transection of the upper one third of left ureter near the left renal pelvis with foreign body (child’s cloth remnant) seen which was initially managed by placement of an infant feeding tube as a bridge between the two transected ends owing to a defect of 3 cm as a temporary emergency salvage procedure. He then underwent per cutaneous nephrostomy insertion. After 3 months, patient underwent definitive repair by left sided pyeloureterostomy over a DJ stent. Conclusion: This case demonstrates the emergency and delayed definitive management of ureteric transection and jejunal injury secondary to penetrating bicycle handlebar injury.