Management of intra-abdominal organ injury following blunt abdominal trauma in children
- 40 Downloads
To evaluate the strategy of a combined diagnostic and therapeutic approach in children with intra-abdominal organ injury following blunt abdominal trauma.
Retrospective clinical study.
Pediatric intensive care unit of an university hospital.
38 children with documented intra-abdominal injury.
Initial non-surgical treatment by a team of pediatric intensivists, radiologists and surgeons.
Measurements and results
Physical examination, oriented blood and urine tests, plain abdominal film, abdominal ultrasound (US) and computed tomography (CT) with contrast. US documented intra-abdominal fluid in 30 and initial organ lesion in 14 out of 31 patients evaluated. Abdominal CT demonstrated the precise organ lesion in 34 out of 36 patients examined with solid organ lesion. Early laparotomy was needed in 7 because of severe shock, pneumoperitoneum and ruptured diaphragm, and delayed surgery in 6 patients. All 38 patients regained a normal life.
The stepped diagnostic approach combined with initial non-surgical treatment by a team provided accurate diagnosis and appropriate treatment. Abdominal US, by demonstrating free intra-abdominal fluid is very sensitive to detect patients with intra-abdominal organ injury, CT scan with contrast is needed to give precise information of specific organ lesions.
Key wordsAbdominal trauma Children Ultrasound CT scan Laparotomy
Unable to display preview. Download preview PDF.
- 1.Breaux CW, Smith G, Georgeson KE (1990) The first two year's experience with major trauma at a pediatric trauma center. J Trauma 30:37–43Google Scholar
- 2.Jaffe D, Wesson D (1991) Emergency management of blunt trauma in children. N Engl J Med 324:1477–1482Google Scholar
- 3.Beaver BL, Colombani PM, Fal A, Fishman E, Bohrer S, Buck JR, Dudgeon DL, Haller JA (1987) The efficacy of computed tomography in evaluating abdominal injuries in children with major head trauma. J Pediatr Surg 22:1117–1122Google Scholar
- 4.Mc Anema OJ, Moore EE, Marx JA (1990) Initial evaluation of the patient with blunt abdominal trauma. Surg Clin North Am 70:495–515Google Scholar
- 5.Oldham KT, Guice KS, Kaufman RA, Martin LW, Noseworthy J (1984) Blunt hepatic injury and elevated hepatic enzymes: a clinical correlation in children. J Pediatr Surg 19:457–461Google Scholar
- 6.Jurkovich GJ, Carrico CJ (1990) Pancreatic trauma. Surg Clin North Am 70:575–593Google Scholar
- 7.Taylor GA, Eichelberger MR, Potter BM (1988) Hematuria. A marker of abdominal injury in children after blunt trauma. Ann Surg 208:688–693Google Scholar
- 8.Goldstein AS, Sclafani SJA, Kupferstein NH, Bass I, Lewis T, Panetta T, Phillips T, Shaftan GW (1985) The diagnostic superiority of computerized tomography. J Trauma 25:938–946Google Scholar
- 9.Davis JW, Hoyt DB, Mackersie RC, McArdle MS (1990) Complications in evaluating abdominal trauma: diagnostic peritoneal lavage versus computerized axial tomography. J Trauma 30:1506–1509Google Scholar
- 10.Feliciano DV (1991) Diagnostic modalities in abdominal trauma: peritoneal lavage, ultrasonography, computed tomography scanning and arteriography. Surg Clin North Am 71:241–256Google Scholar
- 11.Hoelzer DJ, Brian MB, Balsara VJ, Varner WD, Flynn TC, Miner ME (1986) Selection and nonoperative management of pediatric blunt trauma patients: the role of quantitative crystalloid resuscitation and abdominal ultrasonography. J Trauma 26:57–63Google Scholar
- 12.Federle MP, Golberg HI, Kaiser JA, Moss AA, Brooke Jeffrey R, Mall JC (1981) Evaluation by computed tomography. Radiology 138:637–644Google Scholar
- 13.Kane NM, Cronan JJ, Dorfman GS, DeLuca F (1988) Pediatric abdominal trauma: evaluation by computed tomography. Pediatrics 82:11–15Google Scholar
- 14.Taylor GA, Eichelberger MR, O'Donnell R, Bowman L (1991) Indications for computed tomography in children with blunt abdominal trauma. Ann Surg 213:212–218Google Scholar
- 15.Warner RL, Othersen HB, Smith CD (1989) Traumatic pancreatitis and pseudocyst in children: current management. J Trauma 29:597–601Google Scholar
- 16.Karp MP, Cooney DR, Berger PE, Kuhn JP, Jewett TC (1981) The role of computed tomography in the evaluation of blunt abdominal trauma in children. J Pediatr Surg 16:316–323Google Scholar
- 17.Roche BG, Bugmann PH, Le Coultre C (1991) Blunt injuries to liver, spleen, kidney and pancreas in pediatric patients. Eur J Pediatr Surg 2:154–156Google Scholar