Abdominal trauma in children pdf

Reprints and Permissions. Cywes, S. Blunt abdominal trauma in children. Pediatr Surg Int 5, — Download citation. Accepted : 19 December Issue Date : August Anyone you share the following link with will be able to read this content:. Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative.

Skip to main content. Search SpringerLink Search. Abstract Despite improved technology and imaging techniques, problems and controversies still exist as to the best methods of diagnosis and management of visceral injuries in children with blunt abdominal trauma. References 1. Pediatrics — Google Scholar 2. J Trauma — Google Scholar 3. J Pediatr Surg 14—18 Google Scholar 4.

J Trauma — Google Scholar 5. The diagnosis of intra-abdominal injury following blunt trauma depends primarily on the hemodynamic status of the patient. If the patient is hemodynamically stable, CT scan is the ideal test to look for solid organ injury in the abdomen and pelvis. For unstable patients, one may perform an ultrasound Extended Focused Assessment with Sonography for Trauma EFAST or diagnostic peritoneal lavage, both of which are associated with a high rate of false negatives and false positives.

All indications for trauma ultrasound include blunt or penetrating trauma to the torso where there is a suspicion of intraperitoneal hemorrhage, pericardial tamponade, and hemothorax.

Normal Lung: Lung sliding back and forth is normally secondary to the normal anatomy of the parietal and visceral pleural movement. Pneumothorax: With a pneumothorax, there is NO lung sliding back and forth. There will be NO comet tail artifacts. Both the anterior and posterior pericardium should be visualized for anterior or posterior fluid in the pericardium.

Once the airway is protected, it is mandatory to protect the cervical spine. After the primary survey is complete, patients who are hypotensive require aggressive fluid resuscitation. All patients with blunt abdominal trauma who have signs of peritonitis, frank bleeding, or worsening of clinical signs require an immediate laparotomy. Non-surgical treatment in patients with blunt abdominal injury depends on the clinical features, hemodynamic stability and results of the CT scan. Advances in angiography can now help control hemorrhage with the use of embolization therapy, which is more cost effective than laparotomy.

In general, the prognosis of patients with blunt abdominal trauma is good. Mortality rates have substantially decreased in the last two decades as trauma centers have streamlined the approach to diagnosis and management.

According to the Centers for Disease Control, traumatic injury is the leading cause of death in people younger than the age of Many traumatic injuries can be prevented, beginning with awareness and education. Blunt abdominal trauma is in the top three categories of preventable injuries. These include older adults falls and preventable motor vehicle accidents in teens.

Blunt abdominal trauma results in thousands of admission each year, resulting in great costs to the healthcare system. The nurses not only are responsible for monitoring these patients but they also have an important role in patient education. To prevent blunt abdominal trauma, the public has to be educated on wearing a safety belt.

These safety devices have to be worn even if the motor vehicle comes fitted with airbags. More important, the public has to be educated about defensive driving and maintaining a safe distance from other automobiles on the road.

Plus, the public should be told about the consequences of drinking and driving. Finally, the nurse and the pharmacist should educate the public on avoiding distractions in the car like eating, texting or using a mobile phone. In the past two decades, the outcomes of blunt abdominal trauma have improved. However, there are very few papers published on long-term data and hence the eventual outcome of these patients remains unknown.

The ready availability of CT scans has also allowed physicians to closely monitor these patients without performing unnecessary surgeries. This book is distributed under the terms of the Creative Commons Attribution 4. Turn recording back on. National Center for Biotechnology Information , U. StatPearls [Internet].

Search term. Blunt Abdominal Trauma Maria C. Author Information Authors Maria C. Continuing Education Activity Abdominal trauma caused by blunt force is a common presentation in the emergency room seen in adults and children. Introduction Abdominal trauma caused by blunt force is a common presentation in the emergency room seen in adults and children. Etiology The chief cause of blunt abdominal trauma in the United States is motor vehicle accidents. Epidemiology Blunt trauma to the abdomen can occur in people of all ages and is associated with a high morbidity.

Pathophysiology Blunt abdominal trauma can cause damage to the internal organs, resulting in internal bleeding, cause contusions, or injuries to the bowel, spleen, liver, and intestines. History and Physical Because the presentation is often not straightforward, the diagnosis can be difficult and often time-consuming. Evaluation The evaluation of any trauma patient begins with evaluating the airway, accessing the breathing, and managing the circulation.

RUQ right upper quadrant One should evaluate for free fluid in Morison's pouch or the hepatorenal space, the lower pole of the kidney and the space below the diaphragm on the right. In the supine patient, the hepatorenal space is the most dependent area and the least obstructed for fluid flow.

Fluid in the abdomen can move freely to the right pericolic gutter into this space. Translate PDF. Children are not little adults differing in anatomy, physiology and psychology. The flexible ribcage allows direct transmission Chandrasen K Sinha of forces to the thoracic and abdominal organs causing a higher Anthony Lander incidence and severity of visceral injuries. Hence, loss of a relatively small amount of blood may cause significant haemodynamic insta- Abstract bility.

In children, adults. It is more hypovolaemia are obvious whilst adults manifest signs after only common in boys about two- to threefold and in the summer. Mortality and morbidity have been reduced by preventative strategies, for example traffic calming systems, road safety programmes, seat belts, Abdominal trauma better car design and bicycle helmets. A common bicycle and finally rehabilitation. In children, the a circular bruise is seen on the skin and the visceral injury may be absence of a plausible mechanism of injury should raise the suspicion of a duodenal haematoma or pancreatic injury.

In a few cases, the mechanisms are combined. In blunt trauma, solid organs are more commonly Keywords ATLS; blunt injury; children; penetrating trauma; trauma involved in comparison to penetrating injuries. Children compared with adults Management In children, head injury is the commonest followed by injury to The management starts with a primary survey advanced the extremities, with abdominal injuries being the third most paediatric life support guidelines , which after arresting major common site.

However, abdominal injuries are the most haemorrhage, addresses the ABC airway, breathing, circula- commonly unrecognizable fatal injury missed on initial assess- tion. This is followed by a secondary survey which is a head-to- ment. Hence, close and repeated assessments are needed during toe examination. A later tertiary survey can identify any missed initial observations. Important features of abdominal injuries or hidden injuries.

In small children, aero- trauma and with the examination findings e. A regularly aspirated involved. If the child is conscious tenderness should be noted. Importantly distension may develop and so repeated Compared to adults, children are more prone to abdominal examination is mandatory. Occasionally there is a scaphoid injuries, because they have a relatively larger abdominal surface abdomen due to a traumatic diaphragmatic rupture.

Abrasions from seat belt injuries may indicate the force of the deceleration and suggest intraperitoneal damage is likely. Conflicts of interest: none declared.

Conflicts of interest: During assessment of the circulation in the primary survey, two none declared. Note the poor vascularity of the right kidney. DPL may be considered in rare situations in a hae- and-save or cross-match, full blood count, hematocrit, liver modynamically unstable child with a suspected bleed from an function tests and serum amylase measurement.

If there has been a head injury a CT for a CT scan. A focused assessment by sonography for trauma FAST scan is used to evaluate intra-peritoneal free Emergency laparoscopy: can reduce the chance of a negative fluid. It is a sensitive test, but results are operator-dependent, laparotomy in blunt abdominal trauma, where clinical exami- lack specificity and provide no real information on the grade of nation is suggestive of intra-abdominal injuries but there is no organ injuries.

The FAST scan is no substitute for an abdominal suggestive imaging. Laparoscopy accompanied by the local CT scan with contrast. Double contrast is often used and refers to intravenous contrast to study solid Interventional radiology: includes diagnostic angiography and organs and enteral contrast to address potential intestinal therapeutic embolization which may be helpful in on-going injuries.

Endoscopic retrograde chol- angiopancreatography ERCP with or without stenting can have Diagnostic peritoneal lavage: DPL is rarely performed in a specific role in pancreatic duct injuries. Other important children, as positive results do not necessarily require a interventions includes the percutaneous drainage of urinomas in Figure 4 A skin contusion caused by a lap belt which both damaged the Figure 2 Ruptured spleen.

Penetrating injuries: are seen predominantly in adolescents and are more common in boys and the black population. The degree of injury with gunshots is related to the kinetic energy of the missile fired. The kinetic energy is a product of the projectile mass and the square of its velocity. Gunshot injuries can be divided into two categories.

These high-energy injuries cause increased cavitations around the track and can lead to massive soft- tissue injury away from the track.

In general, a formal laparotomy is required in a definite renal trauma, and drainage of pseudocysts following pancreatic penetrating injury. However, in areas with a high prevalence of injuries. The concept of non-operative management of blunt namically stable cases.

Impalement injuries are uncommon, but trauma was first introduced in the late s for splenic injuries, the recommendation is to leave the object in place until they can and is currently accepted as the standard for most solid organ be removed in the operating theatre, because of the potential for injuries.

The management includes bed rest, frequent physical severe haemorrhage. After successful early Hollow viscus injury management contact sporting activities are avoided for a period Lap belt or seat belts in decelerating injuries can cause intestinal after discharge from hospital but there is little evidence to guide injury from flexing of the body around the restraint, causing this advice in relation to the grade of the injury.

Lumbar spine fractures Chance fractures are also seen. Serial clinical indicated in haemodynamically unstable patients with a trans- examination is required. Ischaemic perforation or rupture of the diaphragm. Damage control surgery: has been slowly accepted by some Duodenal injury needs special attention, as it can easily be surgeons as it is in contrast to the philosophy that the best missed. The injury may be a haematoma of the duodenal wall or operation for a patient is one, definitive procedure.

Since a perforation. Perforation may be contained in the retroperitoneal poly-trauma patients can die from intraoperative metabolic space and are difficult to diagnose. The majority of these injuries failure manifest by coagulopathy, hypothermia and metabolic can be managed conservatively with nasogastric aspiration and acidosis during protracted repairs it is best to avoid early parenteral nutrition.

If operative repair is needed, small fresh complex procedures such as formal hepatic resection or pan- injuries can be closured and an omental patch and drainage creaticoduodenectomy. Once metabolic failure is established it is considered, but larger injuries in the presence of significant difficult to control bleeding and correct the derangements.

Damage control surgery spreads the operative procedure into a multi-staged approach.