Abdominal and Genitourinary Trauma

Who could have imagined the influence of James Simpson'S publication in 1968 on the successful nonoperative treatment of select children presumed to have splenic injury. Nearly four decades later, the standard treatment of hemodynamically stable children with splenic injury is nonoperative and this concept has now been successfully applied to most blunt injuries of the liver, kidney, and pancreas as well. Surgical restraint has been the theme based on an increased awareness of the anatomic patterns and physiologic responses characteristic of injured children. Our colleagues in adult trauma care have slowly acknowledged this success and applied many of the principles learned in pediatric trauma to their patients.

Few surgeons have extensive experience with massive abdominal solid organ injury requiring immediate surgery. It is imperative that surgeons familiarize themselves with current treatment algorithms for life-threatening abdominal trauma. Important contributions have been made in the diagnosis and treatment of children with abdominal injury by radiologists and endoscopists. The resolution and speed of computed tomography (CT), screening capabilities of focused abdominal sonography for trauma (FAST), and the percutaneous, angiographic, and endoscopic interventions of non-surgeon members of the pediatric trauma team have all enhanced patient care and improved outcomes. Each section of this chapter will focus on the more common blunt injuries and unique aspects of care in children.