Abdominal hollow viscus trauma in children, injury mechanisms and treatment principles

Abstract

Abdominal hollow viscus trauma represents an important cause of pediatric morbidity, following head, vertebral column, spinal cord and thoracic injuries, whose main mechanisms of production are road traffic accidents, falls with abdominal impact, sports injuries, physical aggression and explosions. If there is a penetrating abdominal trauma, most frequently it associates hollow organ injuries, while abdominal blunt trauma is associated more often with parenchymal injuries, with effects on the hemodynamic status. Imaging and paraclinical investigations used to evaluate an abdominal trauma consist of thoraco-abdominal radiography in orthostatic position, abdominal ultrasonography, diagnostic peritoneal lavage, abdominal computed tomography and exploratory laparoscopy. Unlike penetrating injuries, when surgical exploration is obvious, in the case of young children with abdominal contusions, the injuries involving hollow viscus can be overlooked at time of the initial assessment, because of a poor communication between doctor and patient, difficult interpretation of symptoms when there are other injuries associated, but also because of the initial lack of ultrasound signs of perforation. Delayed diagnosis and adequate treatment lead to extended duration of hospitalization, to elevated costs and rates of morbidity. The incidence of mortality caused by abdominal trauma associated with hollow viscus penetration is approximately 10%, being more elevated as the digestive injuries are multiple or associated with other lesions.