Abdominal and Genitourinary Trauma

Abstract

Trauma is the leading cause of morbidity and mortality in children, with blunt trauma being the most common mechanism. The management of pediatric blunt abdominal trauma has evolved significantly over the last few decades. The initial standard of care was the operative intervention, which proved mostly unsuccessful; however, with an improvement in imaging modalities came a gradual acceptance of nonoperative management. In 2000, the American Pediatric Surgical Association (APSA) Trauma Committee established the first evidenced-based guidelines for nonoperative management of pediatric blunt solid organ injury, based on injury grade determined by diagnostic imaging. Recently, numerous well-designed studies have questioned the use of radiologic grade to determine the need for surgical intervention, leading to current guidelines that emphasize the use of physiologic status and patient’s response to medical interventions. New evidence has emerged to assist in the management of complex pancreatic and duodenal injuries. This chapter will discuss blunt abdominal solid organ and hollow viscus injury, with a focus on diagnostic modalities, and guidelines for nonoperative and operative management in pediatric patients.