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Abdominal Trauma

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Abstract

Abdominal trauma in children is relatively uncommon but may be associated with considerable morbidity and mortality. Further damage should be prevented by optimal evaluation of specific anatomic features that make the injured child more susceptible for solid organ injuries. The spleen is the most frequently injured intra-abdominal solid organ. The liver is the second most injured organ in children. The management of both spleen and liver injuries in children is predominantly non-operative; laparoscopy or laparotomy is only performed in hemodynamic unstable patients and in those with a hollow viscus perforation. Non-operative management of isolated spleen and liver injury in a pediatric trauma center can be successful in more than 95 % of cases. Pancreatic injuries are more difficult to diagnose on both CT scan and with laboratory findings. Treatment options vary by type of injury and surgeons’ preferences. Contusions are mostly treated non-operatively; pancreatic transections (grade III injuries) are treated operatively in some centers and non-operatively in other centers. Endoscopic treatment has become first choice of treatment for pancreatic transections in a few centers provided the pediatric gastroenterologist has the required skills. Hollow viscus injury is the relatively rarest kind of injury. Its diagnosis is still a major challenge and is often delayed. Treatment is similar as to that in adults with the resection of the involved bowel and/or mesentery. Finally, penetrating abdominal trauma accounts for approximately 10 % of abdominal trauma in children and has a high mortality rate, particularly in the very young ones. In conclusion, abdominal trauma in children is rare and both nonoperative treatment and emergency surgical treatment should be adapted to the type of injury of the intra-abdominal organs involved.

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Acknowledgement

We would like to thank J. Hagoort for carefully reading and editing the text.

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Authors and Affiliations

  1. Department of Pediatric Surgery, Erasmus MC Sophia Childrens Hospital, Dr. Molewaterplein 60, Rotterdam, Zuid-Holland, 3000 CB, Netherlands

    Pleun E. A. Hermsen MD & Rene M. H. Wijnen MD, PhD

  2. Department of Pediatric Surgery, Erasmus MC Sophia Childrens Hospital, and Radboudumc Amalia Children’s Hospital, Dr. Molewaterplein 60, Rotterdam, Zuid-Holland, 3000 CB, Netherlands

    Ivo de Blaauw MD, PhD

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  1. Pleun E. A. Hermsen MD
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  2. Rene M. H. Wijnen MD, PhD
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  3. Ivo de Blaauw MD, PhD
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Correspondence to Ivo de Blaauw MD, PhD .

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Editors and Affiliations

  1. Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Derek S. Wheeler

  2. Div. of Critical Care Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA

    Hector R. Wong

  3. University of Michigan Medical School, Ann Arbor, Michigan, USA

    Thomas P. Shanley

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Hermsen, P.E.A., Wijnen, R.M.H., de Blaauw, I. (2014). Abdominal Trauma. In: Wheeler, D., Wong, H., Shanley, T. (eds) Pediatric Critical Care Medicine. Springer, London. https://doi.org/10.1007/978-1-4471-6359-6_17

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