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Blunt abdominal trauma in children: risks of nonoperative treatment
1Department of Pediatric Surgery, Karolinska/St Görans Hospital, Stockholm, Sweden.
Insights
Nonoperative management is highly successful for pediatric splenic ruptures from blunt abdominal trauma. However, conservative approaches for hepatic and pancreatic injuries carry risks, and gastrointestinal perforations require prompt diagnosis and surgical intervention.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Abdominal Trauma
Background:
- Blunt abdominal trauma is a significant cause of injury in children.
- Intraabdominal injuries necessitate careful management strategies to optimize outcomes.
- Previous studies highlight varying success rates for nonoperative management across different organ injuries.
Purpose of the Study:
- To evaluate the outcomes of nonoperative and operative management for various intraabdominal injuries in children following blunt trauma.
- To assess the success rates and complications associated with conservative treatment for splenic, hepatic, pancreatic, and gastrointestinal injuries.
- To identify challenges in diagnosing and managing blunt abdominal trauma in pediatric patients.
Main Methods:
- Retrospective study of 203 pediatric patients with blunt abdominal trauma.
- Analysis of injury types including splenic, hepatic, pancreatic, and gastrointestinal tract injuries.
- Review of management strategies (operative vs. nonoperative) and associated outcomes.
Main Results:
- High splenic salvage rate (100%) with nonoperative management in 145 splenic injuries.
- Hepatic injuries showed potential for conservative management but carried risks of rebleeding.
- Gastrointestinal perforations were challenging to diagnose, with delayed diagnosis leading to severe consequences.
Conclusions:
- Nonoperative management is effective for pediatric blunt splenic trauma.
- Conservative management of hepatic injuries is more hazardous and requires careful monitoring.
- Prompt diagnosis and surgical intervention are crucial for gastrointestinal perforations in pediatric blunt abdominal trauma.
Abstract:
This retrospective study includes 203 children who had intraabdominal injuries after blunt trauma, mainly bicycle accidents and falls. Of 145 patients with splenic injury, seven underwent surgery. There was a 100% splenic salvage rate. Twenty-nine children had hepatic injury and four underwent laparotomy. One patient who was initially treated conservatively had a complicated clinical course with rebleeding that led to two laparotomies. Three of 10 pancreatic injuries were operated on; one of them 4 weeks after the trauma because of a pseudocyst. Nineteen patients had gastrointestinal tract injuries. Of seven intramural hematomas, five were treated nonoperatively. Twelve patients had gastrointestinal perforations. Seven underwent laparotomy without delay. Three patients underwent surgery 24 hours after admission because of severe abdominal rigidity or pneumoperitoneum. There was one case of severe in-hospital delay in which splenic and hepatic injuries were thought to account for the physical findings. At laparotomy 36 hours after admission, a jejunal rupture and necrosis of the transverse colon were found. Nonoperative management of blunt abdominal trauma has been very successful regarding splenic ruptures. Conservative management of hepatic injuries is more hazardous, and treatment of pancreatic injuries is a matter of controversy. Gastrointestinal-tract perforations are difficult to diagnose and important to bear in mind while keeping a conservative attitude toward abdominal trauma.