Pediatric abdominal trauma

Abstract

Major abdominal trauma is the third leading cause of traumatic death in children. Blunt trauma accounts for 85% of pediatric abdominal injuries; the other 15% is by penetrating injuries. Motor vehicular accidents account for 50% of pediatric blunt abdominal trauma, accounting for the most fatalities. Lap-belt injuries, bicycle handle-bar injuries, and sports injuries may cause serious morbidity. Although significant abdominal injuries occur in only 5% of battered children, it is the second most common cause of death. Penetrating injuries are on the rise despite gun control laws. A significant change in the past two decades has been in the evaluation and management of acute abdominal trauma (AAT), especially spleen and liver injuries. AAT with bleeding in the children are divided into three groups: (a) responsive to stabilization, (b) unresponsive to stabilization, and (c) acute abdomen with peritonitis. Most injured children belong to the first category and are treated conservatively in most cases after stabilization and evaluation with CT scan. Sonography is increasingly used for screening. An algorithm for the management of suspected blunt splenic and liver injuries is widely used, with the same principles of management applied in penetrating injuries. Repeated clinical evaluations by a trauma surgeon are critical in the management of abdominal traumas and complimented by computerized tomography and, possibly, ultrasonography.