[Blunt abdominal trauma. Nonoperative management]

During the 7 year period, 1987 to 1994, 48 patients with blunt abdominal trauma were treated in our Hospital. There were splenic injury in 50% cases, liver trauma in 25% and renal injury in 40%. Seven patients suffered injuries to multiple sites. The clinical findings were confirm with ultrasound (47 children) and Computed Tomography scanning (CT) (19 children). Intravenous pyelography were performed in nine cases with previously suspect of renal affection. The CT scan provided diagnosis in four patients with negative findings in the sonography. In the present serine, 42 cases were managed by nonoperative means with 100% survivals. One patient surgically treated died from associated severe head injury. The postoperative complications appeared in ten nonoperatively cases (recurrence of bleeding in four children). 14 of these non surgical patients required blood transfusion, and the mean volume of transfusion was 30 ml/kg. A follow-up abdominal sonography was obtained in all survivors, showing resolution of the injury in all of them. We conclude that non surgical managements must be the first choice in all blunt abdominal trauma in pediatrics. Laparotomy is mandatory in masive bleeding or hemodynamically inestable patients. Ultrasonography is a simple method without risks and fast available, well indicated for diagnosis and follow-up of this children.