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Selective nonoperative management of penetrating abdominal injuries in children

Murat Kemal Cigdem1, Abdurrahman Onen, Mesut Siga

  • 1Department of Pediatric Surgery, Dicle University Medical Faculty, Diyarbakir, Turkey. mkcigdem@hotmail.com

The Journal of Trauma
|December 17, 2009
PubMed

Insights

Selective nonoperative management is feasible for children with penetrating abdominal trauma. Most stab wounds and many gunshot wounds can be treated without immediate surgery if hemodynamically stable and without bowel perforation.

Area of Science:

  • Pediatric Surgery
  • Trauma Surgery
  • Abdominal Trauma

Background:

  • Nonoperative management is standard for blunt abdominal trauma.
  • Operative management is typically standard for penetrating abdominal trauma in children.
  • This study evaluates selective nonoperative management for pediatric penetrating abdominal trauma.

Purpose of the Study:

  • To assess the feasibility of nonoperative management for penetrating abdominal trauma in children.
  • To determine outcomes for children with penetrating abdominal trauma managed nonoperatively versus operatively.

Main Methods:

  • Retrospective evaluation of 90 children with penetrating abdominal trauma (2003-2008).
  • Immediate laparotomy for hemodynamic instability or suspected bowel perforation.
  • Nonoperative management involved serial clinical exams, radiologic evaluation, and hemoglobin monitoring.

Main Results:

  • 51.7% of injuries involved the bowel; 56.6% of patients were treated nonoperatively.
  • 43.4% of patients required surgery; 15.3% of surgically treated patients had no significant organ injury.
  • Only two patients initially managed nonoperatively required delayed surgery; two complications occurred.

Conclusions:

  • Selective nonoperative management is feasible for children with penetrating abdominal trauma.
  • Hemodynamic stability and absence of hollow viscus perforation are key indicators for nonoperative management.
  • This approach can reduce unnecessary laparotomies in pediatric penetrating abdominal trauma.
Abstract

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