Pediatric Abdominal Trauma

The management of children with major abdominal injuries has changed significantly over the past 2 decades. Few surgeons have extensive experience with massive abdominal solid organ injury requiring immediate surgery. Prompt identification of potentially life-threatening intraabdominal injuries with rapid resuscitation and therapeutic intervention is now possible in the overwhelming majority of children. CT has become the standard of care in the evaluation of the pediatric trauma patient. Modern generation CT scanners are highly sensitive in the evaluation of possible solid organ and retroperitoneal injuries. There must be a high index of suspicion for a hollow viscus injury in the child with free intraperitoneal fluid and no identifiable solid organ injury on CT. Clinician-performed sonography for the early evaluation of the injured child has been shown to be useful in many situations but does have limitations. A negative FAST exam does not exclude a significant solid organ or hollow viscus injury. The ready availability of high-resolution CT scanners and the nonoperative management of many pediatric injury patterns have increased، thus minimizing the utility of DPL. The use of laparoscopy for the injured child may have its place in the evaluation armamentarium of the hemodynamically stable patient. The spleen and liver are the organs most commonly injured in blunt abdominal trauma، each accounting for one third of the injuries. Each nonoperative treatment of isolated splenic and hepatic injuries in stable children is now standard practice. The clinical experience accumulated over the past 20 to 30 years، which has settled these concerns، is reviewed.