A 4-year-old girl was beaten by a girl
"A mud and stone alud during a storm."
She was admitted hemodynamically with malaise
140 beats per minute, 16 breaths per minute,
blood pressure 128/69 mmHg, temperature
36.8 oC, transcutaneous oxygen saturation
90% reported chest pain and right elbow.
The
physical examination revealed excoriations, ecchymosis
and a right hypochondrium and flank hematoma
A fracture of the right elbow was diagnosed and treated with conservative treatment.
right hemothorax.
The laboratory showed a hematocrit
analysis of liver enzymes,
normal urine and pancreas.
An ultrasound
and an abdominal computed axial tomography
without contrast were reported as normal.
Cephaltin and tetanus prophylaxis were indicated.
After 48 h of hospitalization, pain in the right flank
It became more intense.
A new ultrasound
abdominal examination showed a normal kidney and fluid in
Douglas bag.
Computed axial tomography
abdominal without contrast detected a collection
right perirenal, which was interpreted as hematoma;
lesions in other organs were not observed
abdominal pain.
A urine analysis showed hematuria with 18-20 red blood cells per field
large increase; it was decided to continue
clinical.
On the fifth day she began with fever
Cefotaxime-metronidazole was indicated.
One
Subsequent ultrasound showed moderate hydronephrosis
right pelvis with increased collection
perirenaline.
An axial tomography was repeated
abdominal computed tomography with intravenous contrast,
which showed an urinoma;
percutaneous drainage of the collection was performed.
1.
After 20 days of treatment, a pyelography
ascending showed avulsion of the right ureter
upper third.
An exploratory lumbotomy
a large perirenal inflammatory process
with devascularisation of the upper urethra
which prevented ureteral repair; nephrectomy was decided.
Hospitalization lasted 40 days and hospitalization lasted 40 days.
favorable outcome.
