Related Experiment Videos
Controversies in abdominal trauma
1Division of Pediatric Surgery, Columbia University College of Physicians & Surgeons, New York, NY, USA.
Insights
Pediatric abdominal injury management has evolved, favoring nonoperative care for solid organ injuries. This review addresses concerns and highlights multidisciplinary approaches for complex biliary and pancreatic ductal injuries in children.
Area of Science:
- Pediatric Surgery
- Trauma Management
- Interventional Radiology
Background:
- The management of pediatric major abdominal injuries has seen significant evolution over the last two decades.
- A shift towards surgical restraint and increased understanding of anatomy and physiology has enabled successful nonoperative care for many solid organ injuries in children.
Purpose of the Study:
- To review the evolution of pediatric abdominal injury treatment.
- To address controversies and concerns regarding nonoperative management strategies.
- To highlight the increasing role of interventional radiology and endoscopy.
Main Methods:
- Review of clinical experience and existing literature.
- Discussion of multidisciplinary treatment approaches for complex injuries.
- Analysis of outcomes and concerns related to nonoperative management.
Main Results:
- Nonoperative management is increasingly successful for pediatric solid organ injuries.
- Interventional radiology and endoscopy play a growing role in managing injured children.
- Multidisciplinary approaches are effective for biliary tree and pancreatic ductal injuries.
Conclusions:
- Nonoperative management of pediatric abdominal injuries is a safe and effective strategy.
- Multidisciplinary collaboration enhances outcomes for complex injuries.
- Addressing surgeon concerns with evidence-based experience is crucial for widespread adoption.
Abstract:
The treatment of children who have major abdominal injuries has changed significantly during the past 2 decades. Surgical restraint has been the theme, and increased awareness of anatomic patterns and physiological responses has prompted successful nonoperative care of many solid organ injuries in children. The contributions of interventional radiologists and endoscopists in the treatment of injured children continue to increase. Injuries to the biliary tree and pancreatic ductal system are now treated with a multidisciplinary approach combining percutaneous, open, and endoscopic procedures. Trauma surgeons unfamiliar with a nonoperative approach often raise questions about the benefits of such treatment. Their concerns include the potential for increased transfusion requirements, increased length of hospital stay, and missed associated injuries; some even question the involvement of pediatric surgeons in nonoperative treatment protocols. The experience that has settled most such controversies is reviewed in this article.