Traumatic duodenal hematoma in the pediatric patient.

Area of Science:

• Pediatric Surgery
• Trauma Surgery
• Gastrointestinal Surgery

Background:

• Duodenal hematomas in children are uncommon injuries resulting from blunt abdominal trauma.
• These injuries can range from isolated hematomas to those associated with other intra-abdominal damage.

Purpose of the Study:

• To evaluate the outcomes of managing duodenal hematomas in pediatric patients.
• To compare the effectiveness of nonoperative versus surgical management strategies.
• To assess the impact of associated injuries on patient outcomes.

Main Methods:

• Retrospective review of twenty pediatric patients with duodenal hematomas treated between 1953 and 1983.
• Classification of injuries into isolated duodenal hematomas and those with associated intra-abdominal injuries.
• Analysis of management approaches including conservative (nasogastric suction, IV fluids) and surgical interventions (laparotomy, evacuation, gastroenterostomy).

Main Results:

• Nonoperative management was successful in all ten children with isolated duodenal hematomas, with a mean hospital stay of six days.
• Surgical management of isolated duodenal hematomas resulted in a mean hospital stay of 17 days.
• In patients with multiple intra-abdominal injuries, conservative management of the duodenal hematoma was often employed, with a mean hospital stay of 32 days and frequent need for nutritional support.

Conclusions:

• Isolated duodenal hematomas in children can be managed successfully with nonoperative treatment, resulting in minimal morbidity.
• Associated intra-abdominal injuries significantly influence hospitalization duration and recovery, often necessitating prolonged nutritional support.
• Nonoperative management should be considered the primary approach for isolated pediatric duodenal hematomas.