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Posttraumatic peritoneal fluid: is it a reliable indicator of intraabdominal injury in children?
1Department of Radiology, George Washington University, Washington, DC, USA.
Insights
Peritoneal fluid in children after blunt abdominal trauma does not always indicate injury. Solid organ injury can occur without fluid, and fluid presence suggests a specific intraabdominal injury.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Trauma Management
Background:
- Blunt abdominal trauma is a common cause of injury in children.
- Computed tomographic (CT) scans are frequently used to evaluate these injuries.
- The significance of peritoneal fluid in the absence of overt injury on CT is not fully understood.
Purpose of the Study:
- To evaluate the reliability of peritoneal fluid as an indicator of intraabdominal injury and its severity in children with blunt abdominal trauma.
- To determine the association between peritoneal fluid and the need for surgical intervention (laparotomy).
Main Methods:
- Retrospective review of clinical data and CT scans from 1,486 children with blunt abdominal trauma.
- CT assessment for presence, location, and severity of intraabdominal injuries and peritoneal fluid.
- Correlation of CT findings with management type (surgical vs. nonsurgical) and clinical outcomes.
Main Results:
- Of 326 children with CT-detected abdominal injuries, 121 (37%) had no peritoneal fluid; 15% of these had multi-organ injuries.
- Splenic injuries were more severe in children with peritoneal fluid.
- Peritoneal fluid was present in 259 children (17%), with 80% having concomitant intraabdominal injury, including solid organ injuries (68%) and hollow viscus/mesenteric injury (11%).
Conclusions:
- Solid organ injury in children with blunt abdominal trauma can occur independently of peritoneal fluid.
- The presence of peritoneal fluid on CT in children with blunt abdominal trauma warrants suspicion for an associated intraabdominal injury.
Abstract:
Clinical data and computed tomographic (CT) scans for 1,486 children evaluated after blunt abdominal trauma were reviewed to determine whether peritoneal fluid is a reliable indicator of the presence and severity of associated intraabdominal injury and the need for laparotomy. The CT scans were assessed for presence, location, and severity of intraabdominal injury, and amount of peritoneal fluid. Type of management (surgical or nonsurgical), indications for surgical management, overall hospital course, and clinical outcome were recorded at the time of discharge. Of the 326 children with abdominal injuries detected by CT, 121 (37%) had no associated peritoneal fluid collections. Eighteen (15%) of these children had injury to more than one abdominal organ. Splenic injuries by CT criteria were more severe in children with associated peritoneal fluid than in those with no associated fluid (P < .003). There were no significant differences in CT grading of liver and renal injuries among those with and without associated peritoneal fluid (P > .67). Two hundred fifty-nine (17%) of the 1,486 children had peritoneal fluid demonstrated by CT. Eighty percent of these children had concomitant intraabdominal injury. Associated injuries included solid organ injuries (in 68% of patients) hollow viscus or mesenteric injury (11%), isolated pelvic fracture (4%), and hypoperfusion syndrome (5%). Thirty-one patients (12%) had injury to more than one abdominal organ. Only 27 (11%) patients had small "unexplained" collections of peritoneal fluid in which no associated injury was detected through CT or clinical follow-up. The authors conclude that (1) solid organ injury is frequently present in the absence of peritoneal fluid, and (2) the identification of peritoneal fluid after blunt trauma should lead one to suspect that a specific intraabdominal injury is the cause of the fluid.