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[Haemorrhagic shock after severe abdominal trauma in children: knowing when to change from conservative to surgical

R Jouffroy1, N Bourdaud, H Cuttaree

  • 1Département d'anesthésie-réanimation, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.

Annales Francaises D'Anesthesie Et De Reanimation
|April 20, 2010
PubMed

Insights

Rare pediatric abdominal vascular injuries from falls can cause shock. Early surgery, though unconventional, successfully treated a child with hepatic artery rupture and splenic vein injury.

Area of Science:

  • Pediatric surgery
  • Trauma surgery
  • Vascular surgery

Background:

  • Abdominal vascular injuries are rare in children following trauma.
  • Hemorrhagic shock diagnosis can be challenging in pediatric multi-trauma patients.
  • Current pediatric abdominal trauma management often favors conservative approaches, reserving surgery for hemodynamically unstable cases.

Observation:

  • A 7-year-old girl sustained severe abdominal trauma from a 10-meter fall.
  • The patient presented with hepatic artery rupture and splenic vein injury.
  • She experienced hemorrhagic shock requiring immediate intervention.

Findings:

  • Aggressive resuscitation and early exploratory laparotomy were performed.
  • Surgical hemostasis successfully controlled the intra-abdominal bleeding.
  • The child's hemodynamic status stabilized, leading to a favorable outcome.

Implications:

  • This case challenges the predominantly conservative management of pediatric abdominal vascular injuries.
  • Early surgical intervention should be considered in select cases of severe pediatric abdominal trauma with vascular injury.
  • Prompt surgical management can be life-saving in pediatric patients with significant intra-abdominal hemorrhage.

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