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Blunt abdominal trauma in children: epidemiology, management, and management problems in a developing country
E A Ameh1, L B Chirdan, P T Nmadu
1Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Insights
Blunt abdominal trauma (BAT) in Nigerian children is mainly caused by road traffic accidents. Advanced imaging could prevent over half of unnecessary surgeries, improving outcomes for pediatric trauma patients.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Public Health in Developing Countries
Background:
- Trauma is a leading cause of death in children globally, with increasing significance in developing regions.
- In developed nations, advanced imaging has reduced the need for exploratory surgery in pediatric blunt abdominal trauma (BAT).
- This study examines pediatric BAT management in a Nigerian teaching hospital, a setting with limited advanced imaging availability.
Purpose of the Study:
- To review the epidemiology and management of pediatric blunt abdominal trauma (BAT) in a developing country.
- To assess the rate of unnecessary laparotomies and identify potential cases for non-operative management.
- To highlight the impact of limited advanced imaging on surgical decision-making in pediatric trauma.
Main Methods:
- Retrospective review of 57 pediatric patients (≤15 years) with BAT over 12 years at Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
- Data collected included demographics, injury mechanisms, diagnostic methods, surgical interventions, and outcomes.
- Clinical diagnosis was primary, supplemented by diagnostic peritoneal lavage/paracentesis; ultrasonography was used in 2 cases, CT scan in none.
Main Results:
- Road traffic accidents (RTAs) caused 57% of injuries, primarily in pedestrians aged 5-9 years; falls accounted for 36%.
- Laparotomy was performed in 53 patients; 2 died pre-operatively. Splenic injuries were most common (34 cases).
- In retrospect, 51% of patients with BAT could have been managed non-operatively with access to advanced imaging.
Conclusions:
- Pediatric blunt abdominal trauma in this Nigerian population is predominantly caused by RTAs involving pedestrians.
- The high rate of laparotomy (93%) underscores the limitations imposed by the lack of advanced imaging modalities.
- Implementing advanced imaging could significantly reduce unnecessary laparotomies, improving patient outcomes in pediatric trauma care.
Abstract:
Trauma is the leading cause of death in children in developed countries. In tropical Africa, it is only beginning to assume importance as infections and malnutrition are controlled. In developed countries, the availability of advanced imaging modalities has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma (BAT) in children. This report reviews the epidemiology, management, and unnecessary laparotomies for pediatric BAT in a developing country in a retrospective review of 57 children aged 15 years or less at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria over 12 years. The average age was 9 years and the male-female ratio 3.8:1. Seventy-four percent (74%) of abdominal injuries in children were due to blunt trauma. The commonest causes of injury were road traffic accidents (RTA) (57%), 88% in pedestrians and 59% in children aged 5-9 years. Falls were the cause of trauma in 36%, 60% of them aged 10-15 years. Other causes of injury were sports in 5% and animals in 2%. Diagnosis was clinical, supported by diagnostic peritoneal lavage or paracentesis. Two patients had ultrasonography, and none had computed tomography. Fifty-three patients had a laparotomy, 2 died before surgery, 1 was managed nonoperatively, and in 1 surgery was declined. There were 34 splenic injuries, 20 treated by splenic preservation, splenectomy in 13, and non-operative in 1. Fourteen gastrointestinal injuries were treated in 12 patients. Of 9 hepatic injuries, 4 were minor and were left untreated, 3 were repaired, 1 was packed to arrest hemorrhage, and a lacerated accessory liver was excised. Four injuries to the urinary tract (bladder contusion 2, bladder rupture 1, ruptured hydronephrotic kidney 1) were treated accordingly. There were 4 retroperitoneal hematomas associated with other intra-abdominal injuries and 2 pancreatic contusions. One lacerated gallbladder was treated by cholecystectomy and a ruptured left hemidiaphragm was repaired transperitoneally. In retrospect, 27 (51%) patients could have been managed by observation (splenic injury 20, liver injury 5, bladder contusion 2) using advanced imaging modalities. One patient developed an intra-abdominal abscess following splenorrhaphy. The average hospital stay was 17 days. Mortality was 8 (14.5%) from gastric perforation (3), liver injury (2), splenic injury (1), and 2 patients died before surgery. BAT in this population results predominantly from RTA in pedestrians. Laparotomy may be avoided in 51% of cases if advanced imaging modalities are readily available.