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[Contusions of the abdomen in children]
Insights
Advances in pediatric abdominal contusion treatment include conservative spleen surgery and improved imaging. Ultrasound and CT scans reduce invasive procedures, though hepatic lesions remain challenging.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Diagnostic Imaging
Context:
- Treatment of abdominal contusions in children has evolved significantly.
- Conservative management of splenic injuries is increasingly successful.
- Diagnostic imaging modalities have advanced, improving accuracy and reducing invasiveness.
Purpose:
- To review the management of severe abdominal contusions in children.
- To evaluate the role of diagnostic imaging, including ultrasound and CT scans.
- To highlight challenges in managing associated hepatic and visceral lesions.
Summary:
- Conservative spleen management and abstention from surgery are now common for splenic injuries.
- Ultrasound and CT scans have decreased the need for peritoneal lavage, improving diagnostic reliability.
- Hepatic lesions present management difficulties due to challenges in precise localization and anatomical assessment.
Impact:
- Improved diagnostic accuracy for abdominal trauma in children.
- Reduced need for invasive diagnostic procedures like peritoneal lavage.
- Enhanced understanding of managing complex abdominal injuries, particularly hepatic lesions.
Abstract:
Marked progress in the treatment of abdominal contusions in children over the last few years is due to the development of conservative surgery to the spleen and even possible abstention from operation following splenic injuries. The reliability of paraclinical exploratory procedures has increased, and ultrasound and CT scan imaging have reduced the need for peritoneal puncture-lavage. However, and unresolved problem concerns associated visceral lesions, and although treatment of isolated splenic injuries is fairly well detailed that of hepatic lesions raises difficulties because of lack of data on exact location of lesions and the anatomical damage produced. Injuries provoked and treatment instituted are described in relation to children admitted for severe abdominal contusions between 1970 and 1985. Since 1984, 52 children have undergone initial ultrasound imaging and only 6 (8%) peritoneal puncture-lavage procedures were necessary. Ultrasound is of value for diagnosis of a hemoperitoneum but of very limited use for defining sites of lesions, a more refined diagnosis being established by computed tomography. Finally, routine simplified emergency intravenous urography is performed in any child with severe abdominal contusion with even microscopic hematuria to detect possible subadventitial rupture of renal artery.