Blunt Abdominal Trauma

Abstract

Trauma is the leading cause of disability and death in children. Pediatric trauma patients present unique clinical challenges as compared to adults, including different mechanisms of injury, physiologic responses, and indications for operative versus non-operative management. Major causes of blunt abdominal trauma (BAT) in children include motor vehicle or bicycle accidents, pedestrian injuries, and falls. 6–13% of patients experience Intra Abdominal Injury (IAI). Liver and spleen are the most commonly injured solid organs followed by kidneys, hollow viscus injuries, pancreatic lacerations and injuries to the abdominal vasculature. Not infrequently, blunt abdominal trauma may not be apparent upon inspection and must be suspected from history, mechanism of injury, and physical examination. According to the core principles of the Advanced Trauma Life Support (ATLS) evaluation for IAI should be performed during the secondary survey. Physical signs of blunt abdominal trauma include ecchymosis, skin abrasions, and abdominal distention with or without peritonitis. Management of BAT is guided by the clinical presentation and hemodynamic status rather than severity on imaging. Non-operative management (NOM) is the standard of care for hemodynamically stable patients. However, this treatment approach may fail due to hemodynamic instability or peritonitis in case of hollow viscus injuries, therefore in these cases emergent laparotomy is indicated after resuscitation.