Abdominal Solid Organ Injuries Research Articles

Management of blunt trauma abdomen in a tertiary care teaching hospital: a surgical audit

Background: Blunt abdominal trauma is a common scenario in Emergency department and the common cause being road traffic accidents. With this study we present our experience with blunt trauma of abdominal solid organ injuries over a period of 12 months.Methods: A retrospective study was conducted among 45 blunt trauma of abdominal solid organ injuries who presented to the emergency room of Department of General Surgery of Mysore Medical College and Research Institute, Mysore from 1st January 17 to 31st December 2017.All date were retrieved from medical records and statistical analysis was performed using Epi info version 7.Results: Mean age of study population was 31.46 years. 78.2% of the patients were males. Thirty-three (73.3%) patients undergone non-operative management. Splenic injury was reported as the most common abdominal solid organ injury followed by liver.Conclusions: With the advent of newer investigative modalities like contrast enhanced computed tomography (CECT) abdomen, more and more cases of blunt trauma abdominal solid organ injury can be managed non-operatively with effective ICU care. High-grade injuries do not preclude non-operative management.

Cirrhosis increases complication rate and overall mortality in patients with traumatic lung injury

Introduction Hepatic cirrhosis is associated with an increased mortality in trauma. However, the association between cirrhosis and outcomes in traumatic lung injury has not been investigated. We hypothesize that cirrhosis adversely affects mortality and increases complications after traumatic lung injury. Methods A retrospective analysis of the National Trauma Data Bank was performed between 2007 and 2015. Patients ≥ 18 years of age with traumatic lung injury were identified and grouped by the presence or absence of cirrhosis. Patients that died in the emergency department or those with a severe (grade > 3) abbreviated injury scale for head trauma were excluded. The primary outcome was mortality. Results Out of 6,774,260 patients, 578,883 (8.5%) presented with traumatic lung injury. Of these, 1971 (0.3%) had a concomitant diagnosis of cirrhosis. The cirrhotic group was significantly older (median age, 56 versus 42 years, p < 0.001) and more likely to be hypotensive on admission (9.3% versus 6.7%, p < 0.001). There was no difference in injury severity score (p > 0.05). Patients with cirrhosis had a significantly longer median length of stay (12.5 versus 8.8 days, p < 0.001), rates of acute kidney injury (7.6% versus 1.4%, p < 0.001), acute respiratory distress syndrome (7.3% versus 2.9%, p < 0.001), pneumonia (12.9% versus 5.9%, p < 0.001), and overall mortality (20.6% versus 5.6%, p < 0.001). After adjusting for significant covariates, cirrhosis (OR = 6.26, 95% CI = 5.49–7.14, p < 0.001) was found to be an independent risk factor for mortality in patients with traumatic lung injury. Conclusion Cirrhosis in patients with traumatic lung injury is associated with more than a sixfold higher risk of mortality and increased rates of complications such as acute kidney injury and acute respiratory distress syndrome. While much focus has been on increased mortality of cirrhosis in patients with concomitant abdominal solid organ or traumatic brain injury, our study suggests cirrhosis with traumatic lung injury to possibly be an even worse prognosticator.

Nonoperative management of penetrating abdominal solid organ injuries in children

BackgroundNonoperative management (NOM) of penetrating solid organ injuries (SOI) has not been well described in the pediatric population. The objective of this study was to characterize the epidemiology, injury patterns, and factors associated with trial and failure of NOM. MethodsThis is a retrospective cohort analysis of the National Trauma Data Bank for the period of 2007-2014. The study population included patients ≤18 y with penetrating injury to the liver, spleen, or kidney. NOM was defined as no operative intervention (exploratory laparotomy or operation involving the liver, spleen, or kidney) < 4 h of emergency department arrival. Failed NOM was defined as operative intervention ≥4 h after emergency department arrival. Multivariate logistic regression explored clinical factors potentially associated with trial and failure of NOM. ResultsOf 943,000 pediatric trauma patients included in the National Trauma Data Bank, 3005 (0.32%) met our inclusion criteria. Median age was 17.0 y; 88.8% were male. Gunshot wounds (GSW) accounted for 71.7% of injury mechanisms and stab wounds accounted for the remaining 28.3%. Median injury severity score was 9 (interquartile range: 5-13). Two thousand one hundred and twenty-one (70.6%) patients sustained kidney injury, 1210 (40.3%) liver injury, and 159 (5.3%) splenic injury. NOM was pursued in 615 (20.5%) patients. Factors significantly associated with immediate operative intervention included GSW, hypotension, and associated hollow viscus injury. Failed NOM was identified in 175 patients (28.5%). Factors significantly associated with failed NOM included GSW, high-grade SOI, and associated hollow viscus injury. Overall mortality was 26 (0.9%). ConclusionsNOM can be safe in a carefully selected group of pediatric patients with penetrating SOI. Future prospective studies are warranted to validate its feasibility.

Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference.

Nonoperative management of abdominal solid-organ injuries following blunt trauma in adults: Results from an International Consensus Conference.

Use of angiographic embolization in trauma-induced pediatric abdominal solid organ injuries.

Knowledge of the utility of angiographic embolization (AE) in pediatric cases of blunt abdominal solid organ trauma injuries is limited. The current study is an examination of AE as an effective and reliable method to control bleeding in patients with persistent bleeding due to blunt trauma-induced abdominal solid organ injury. This was a retrospective examination of patients <17 years of age who had experienced blunt abdominal solid organ injury and who presented at a single institution within 4 years. A statistical analysis of the data was performed. The mean length of intensive care unit stay was 4 days for those who underwent embolization (n=11), and the mean length of hospital stay was 12 days. The average pre-AE blood loss, as measured by the decrease in hematocrit (%) from admission to embolization, was -7.33+-5.3% (p<0.001). The average post-AE blood loss, as measured by the change in hematocrit 72 hours post AE, was 2+-0.97% (p>0.05). All of the patients were discharged with a full recovery. AE was a safe and effective method to control solid organ hemorrhage in pediatric patients with blunt abdominal injuries.

Isolated Common Hepatic Duct Injury after Blunt Abdominal Trauma

Extrahepatic bile duct injury is commonly associated with hepatic, duodenal, or pancreatic injuries, and isolated extrahepatic bile duct injury is rare. We report a patient who presented with an isolated extrahepatic bile duct injury after blunt trauma. A 50-year-old man was referred to our hospital after having suffered a fall down injury. His laboratory findings showed hyperbiliribinemia with elevated aspartate aminotransferase and alanine aminotransferase level. Initial abdominal computed tomography (CT) showed a mild degree of hemoperitoneum without evidence of abdominal solid organ injury. On the 3rd day of hospitalization, the patient complained of dyspnea and severe abdominal discomfort. Follow-up abdominal CT showed no significant interval change. Owing to the patient’s condition, Emergency laparotomy revealed a large amount of bile-containing fluid collection and about 1 cm in size laceration on the left lateral side of the common hepatic duct. Primary repair of the injured bile duct with T-tube insertion was performed On postoperative day (POD) 30, endoscopic retrograde cholangiopancreatography showed minimal bile leakage and endoscopic sphincteroplasty and endoscopic retrograde biliary drainage were performed. On POD 61, the T-tube was removed and the patient was discharged. Keywords: Abdominal injuries; Hepatic duct

Evaluation and Management of Blunt Solid Organ Trauma

Trauma is a leading cause of death in patients under the age of 45 and generally associated with a high kinetic energy event such as a motor vehicle accident or fall from extreme elevations. Blunt trauma can affect every organ system and major vascular structure with potentially devastating effect. When we consider abdominal solid organ injury from blunt trauma, we usually think of the liver, spleen, and kidneys. However, all of the abdominal organs, including the pancreas and adrenal glands, may be involved. Blunt hepatic trauma is more commonly associated with venous bleeding rather than arterial injury. Stable venous injury is often managed conservatively; when the patient is hemodynamically unstable from venous hepatic injury, operative management should be first-line therapy. When the injury is arterial, endovascular therapy should be initiated. Blunt trauma to the spleen is the most common cause of traumatic injury to the spleen. Management is controversial. In our institution unstable patients are taken to the operating room, and stable patients with Grades IV-V injuries and patients with active arterial injury are taken for endovascular treatment. Renal injuries are less common, and evidence of arterial injury such as active extravasation or pseudoaneurysm is warranted before endovascular therapy. Pancreatic trauma is uncommon and usually secondary to steering wheel/handlebar mechanism injuries. Adrenal injuries are rare in the absence of megatrauma or underlying adrenal abnormality.

Pneumatoceles in pediatric blunt trauma: Common and benign

IntroductionTraumatic pneumatoceles are reported to be rare in children and to have an uncertain clinical significance. We report a single institution series of traumatic pneumatoceles to better define their frequency and clinical significance. MethodsAfter obtaining approval from the IRB, data were extracted from the trauma registry of a level 1 pediatric trauma center on children diagnosed with a pulmonary contusion (International Classification of Diseases-9th edition diagnosis codes: 861.21 to 861.31) who presented between June, 2006 and September, 2016. Patient demographics, mechanism of injury, injury severity score, diagnosis and procedure codes, length of hospital stay, outcome, imaging techniques and findings with attention to the identification of a pneumatocele, were examined. ResultsOf the 10,229 trauma admission, 204 children were identified as having a pulmonary contusion, 25 of whom (12.3%) were diagnosed with a pneumatocele. Their mean age was 13years (3–17). Seventy-six percent (19) were male. The most common mechanism of injury was a motor vehicle collision (10), followed by falls (6), and sports (5). Sixteen children (64%) suffered a long bone fracture, 12 (48%) an abdominal solid organ injury and 3 (12%) a traumatic brain injury. The mean Injury Severity Score was 17 (9–34). Twenty-three patients presented as transfers. There were no fatalities. The pneumatocele was identified on chest computerized tomography (CT) alone in 15 (60%), on chest CT and chest radiograph (CXR) in 3 (12%), the upper portions of an abdominal CT in 6 (24%) and on CXR alone in 1 (4%). Seven patients were found to have a solitary pneumatocele and 18 patients had 2 or more. The largest pneumatocele was 3.7cm in diameter. Ten children (40%) were admitted to the intensive care unit, 3 of whom required intubation. One patient (4%) had a respiratory complication: pneumonia. Three patients underwent chest tube placement for: pneumothorax, hemothorax and hemopneumothorax. No child underwent intervention specific to the pneumatocele. Seventeen (68%) patients were seen in follow-up in Trauma Clinic and the remainder by another practitioner ranging from 1week to 6months after injury. One child (4%) underwent a follow-up chest CT to rule out a congenital pulmonary malformation 6months after injury and this demonstrated complete resolution of the pneumatocele. ConclusionThe incidence of traumatic pneumatoceles among children with a pulmonary contusion was 12.3% in this series, but is probably higher given that only 24% were visible on radiographs and a small minority of children with pulmonary contusions underwent chest CT. Pneumatoceles are common in children with pulmonary contusions, but are usually small. The majority do not appear to be clinically significant nor require follow-up imaging. Level of evidenceIV.

Diagnostic accuracy of contrast enhanced ultrasound in patients with blunt abdominal trauma presenting to the emergency department: a systematic review and meta-analysis

We aimed to investigate the diagnostic accuracy of contrast-enhanced ultrasound (CEUS) in evaluating blunt abdominal trauma for patients presenting to the emergency department. Electronic search of Scopus and Pubmed was performed from inception to September 2016. Human studies investigating the diagnostic accuracy of CEUS in identifying abdominal solid organ injuries were included. Risk of bias was assessed using the QUADAS tool. A total of 10 studies were included in the study and 9 of them were included for meta-analysis. The log(DOR) values ranged from 3.80 (95% CI: 2.81–4.79) to 8.52 (95% CI: 4.58–12.47) in component studies. The combined log(DOR) was 6.56 (95% CI: 5.66–7.45). The Cochran’s Q was 11.265 (p = 0.793 with 16 degrees of freedom), and the Higgins’ I2 was 0%. The CEUS had a sensitivity of 0.981 (95% CI: 0.868–0.950) and a false positive rate of 0.018 (95% CI: 0.010–0.032) for identifying parenchymal injuries, with an AUC of 0.984. CEUS performed at emergency department had good diagnostic accuracy in identifying abdominal solid organ injuries. CEUS can be recommended in monitoring solid organ injuries, especially for patients managed with non-operative strategy.

Safety of early ambulation following blunt abdominal solid organ injury: A prospective observational study

BackgroundThere is continued debate regarding the optimal period of bed-rest and in-hospital monitoring for non-operative management of solid organ injury following blunt trauma. MethodsSingle center, prospective, observational study of blunt solid organ injuries from 07/2014–02/2016, managed initially without surgical or angiographic intervention. Early ambulation was defined as ≤24 h. Results79 patients met inclusion criteria, with 36 (45.6%) in the early ambulation group and 43 (54.4%) in the late ambulation group. There were zero complications in the early ambulation group, and three complications in the late ambulation group (complications, p = 0.246; further interventions, p = 0.498). Median ICU LOS was zero days and three days for early vs. late ambulation, p = 0.001. Median total LOS was two days and five days for early vs. late ambulation, p < 0.001. ConclusionEarly ambulation is safe in patients undergoing non-operative management of their solid organ injury, and may result in a reduced length of stay.

Feasibility of Pure Ultrasonography Guided Percutaneous Nephrolithotomy in Flank Position

Background: Although percutaneous nephrolithotomy is most commonly performed with fluoroscopic access, yet, phobia and risks of radiation exposure are 2 important dilemmas. Herein the feasibility of flank position ultrasound guided percutaneous nephrolithotomy for management of renal stones was assessed. Methods: Between September 2012 and June 2016, 250 cases (134 males and 116 females) with renal stone underwent ultrasonography-guided percutaneous nephrolithotomy under lateral decubitus position. The exclusion criteria were active urinary tract infection and bleeding status. The peri-operative surgical outcomes were recorded and analyzed. Results: The mean age of patients was 42.0 ± 13.4 years. Twelve patients were children under 12 years old. Mean size of the stones was 4.2 ± 1.1 cm (range from 2.5 to 5.3 cm). Mean access and operative times were 15.5 ± 2.3 and 68 ± 14.5 minutes, respectively. In 45% of patients, superior calyx was selected for access. History of previous open stone surgery was obtained in 24 cases. Early complete stone free rate (SFR) was 68%, and after auxiliary procedures (SWL and TUL), this increased to 88%. The mean hemoglobin reduction was 1.9 ± 0.9 gr/dL. Blood transfusion was needed in 6 cases (2.4%). Prolonged or delay hemorrhage did not occur in any of the patients. One patient was complicated by moderate degree of pneumothorax and managed with chest tube insertion. Solid or viscus abdominal organ injury had not happened. Conclusions: This study suggested that the feasibility and outcomes of ultrasonography-guided percutaneous nephrolithotomy are comparable with the standard fluoroscopic approach. Also flank position can facile this procedure.

Contrast enhanced ultrasound for the evaluation of blunt pediatric abdominal trauma

IntroductionBlunt abdominal trauma is a common problem in children. Computed tomography (CT) is the gold standard for imaging in pediatric blunt abdominal trauma, however up to 50% of CTs are normal and CT carries a risk of radiation-induced cancer. Contrast enhanced ultrasound (CEUS) may allow accurate detection of abdominal organ injuries while eliminating exposure to ionizing radiation. MethodsChildren aged 7–18years with a CT-diagnosed abdominal solid organ injury underwent grayscale/power Doppler ultrasound (conventional US) and CEUS within 48h of injury. Two blinded radiologists underwent a brief training in CEUS and then interpreted the CEUS images without patient interaction. Conventional US and CEUS images were compared to CT for the presence of injury and, if present, the injury grade. Patients were monitored for contrast-related adverse reactions. ResultsTwenty one injured organs were identified by CT in eighteen children. Conventional US identified the injuries with a sensitivity of 45.2%, which increased to 85.7% using CEUS. The specificity of conventional US was 96.4% and increased to 98.6% using CEUS. The positive predictive value increased from 79.2% to 94.7% and the negative predictive value from 85.3% to 95.8%.Two patients had injuries that were missed by both radiologists on CEUS. In a 100kg, 17year old female, a grade III liver injury was not seen by either radiologist on CEUS. Her accompanying grade I kidney injury was not seen by one of the radiologist on CEUS. The second patient, a 16year old female, had a grade III splenic injury that was missed by both radiologists on CEUS. She also had an adjacent grade II kidney injury that was seen by both.Injuries, when noted, were graded within 1 grade of CT 33/35 times with CEUS.There were no adverse reactions to the contrast. ConclusionCEUS is a promising imaging modality that can detect most abdominal solid organ injuries in children while eliminating exposure to ionizing radiation. A multicenter trial is warranted before widespread use can be recommended. Level of evidenceLevel II; Diagnostic Prospective Study.

Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment.

The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures. Specific attention is also required for flail chest and for fractures due to pediatric nonaccidental trauma. Rib fractures are associated with significant morbidity and mortality, both of which increase as the number of fractured ribs increases. Key complications associated with rib fracture include pain, hemothorax, pneumothorax, extrapleural hematoma, pulmonary contusion, pulmonary laceration, acute vascular injury, and abdominal solid-organ injury. Congenital anomalies, including supernumerary or accessory ribs, vestigial anterior ribs, bifid ribs, and synostoses, are common and should not be confused with traumatic pathologic conditions. Nontraumatic mimics of traumatic rib injury, with or without fracture, include metastatic disease, primary osseous neoplasms (osteosarcoma, chondrosarcoma, Ewing sarcoma, Langerhans cell histiocytosis, and osteochondroma), fibrous dysplasia, and Paget disease. Principles of management include supportive and procedural methods of alleviating pain, treating complications, and stabilizing posttraumatic deformity. By recognizing and accurately reporting the imaging findings, the radiologist will add value to the care of patients with thoracic trauma. Online supplemental material is available for this article. ©RSNA, 2017.

Traumatic Rib Injury: Patterns, Imaging Pitfalls, Complications, and Treatment-Erratum.

The ribs are frequently affected by blunt or penetrating injury to the thorax. In the emergency department setting, it is vital for the interpreting radiologist to not only identify the presence of rib injuries but also alert the clinician about organ-specific injury, specific traumatic patterns, and acute rib trauma complications that require emergent attention. Rib injuries can be separated into specific morphologic fracture patterns that include stress, buckle, nondisplaced, displaced, segmental, and pathologic fractures. Specific attention is also required for flail chest and for fractures due to pediatric nonaccidental trauma. Rib fractures are associated with significant morbidity and mortality, both of which increase as the number of fractured ribs increases. Key complications associated with rib fracture include pain, hemothorax, pneumothorax, extrapleural hematoma, pulmonary contusion, pulmonary laceration, acute vascular injury, and abdominal solid-organ injury. Congenital anomalies, including supernumerary or accessory ribs, vestigial anterior ribs, bifid ribs, and synostoses, are common and should not be confused with traumatic pathologic conditions. Nontraumatic mimics of traumatic rib injury, with or without fracture, include metastatic disease, primary osseous neoplasms (osteosarcoma, chondrosarcoma, Ewing sarcoma, Langerhans cell histiocytosis, and osteochondroma), fibrous dysplasia, and Paget disease. Principles of management include supportive and procedural methods of alleviating pain, treating complications, and stabilizing posttraumatic deformity. By recognizing and accurately reporting the imaging findings, the radiologist will add value to the care of patients with thoracic trauma. Online supplemental material is available for this article. ©RSNA, 2017.

Outcomes of an accelerated care pathway for pediatric blunt solid organ injuries in a public healthcare system

PurposeAn accelerated clinical care pathway for solid organ abdominal injuries was implemented at a level one pediatric trauma center. The impact on resource utilization and demonstration of protocol safety was assessed. MethodsData were collected retrospectively on patients admitted with blunt abdominal solid organ injuries from 2012 to 2015. Patients were subdivided into pre- and post-protocol groups. Length of hospital stay (LOS) and failure of non-operative treatment were the primary outcomes of interest. Results138 patients with solid organ injury were studied: 73 pre- (2012–2014) and 65 post-protocol (2014–2015). There were no significant differences in age, gender, injury severity score (ISS), injury grade, or mechanism (p>0.05). LOS was shorter post-protocol (mean 5.6 vs. 3.4days; median 5 .0 vs. 3.0days; p=0.0002), resulting in average savings of $5966 per patient. Patients in the protocol group mobilized faster (p<0.0001) and experienced fewer blood draws (p=0.02). On multivariate analysis, protocol group (p<0.001) and ISS (p<0.001) were independently associated with LOS. There were no differences between groups in the need for operation, embolization, or transfusion. ConclusionAn accelerated care pathway is safe and effective in the management of pediatric solid organ injuries with early mobilization, less blood draws, and decreased LOS without significant morbidity and mortality. Level of evidenceTherapeutic, cost effectiveness, level III.

Traumatic Abdominal Solid Organ Injury Patients Might Benefit From Thromboelastography-Guided Blood Component Therapy.

BackgroundThromboelastography (TEG) has been utilized for the guidance of blood component therapy (BCT). We aimed to investigate the association between emergent TEG-guided BCT and clinical outcomes in patients with traumatic abdominal solid organ (liver and/or spleen) injuries.MethodsA single center retrospective study of patients who sustained traumatic liver and/or spleen injuries receiving emergent BCT was conducted. TEG was ordered in all these patients. Patient demographics, general injury information, outcomes, BCT, and TEG parameters were analyzed and compared in patients receiving TEG-guided BCT versus those without.ResultsA total of 166 patients were enrolled, of whom 52% (86/166) received TEG-guided BCT. A mortality of 12% was noted among patients with TEG-guided BCT when compared with 19% of mortality in patients with non-TEG-guided BCT (P > 0.05). An average of 4 units of packed red blood cell (PRBC) was received in patients with TEG-guided BCT when compared to an average of 9 units of PRBC received in non-TEG-guided BCT patients (P < 0.01). A longer hospital length of stay (LOS, 19 ± 16 days) was found among non-TEG-guided BCT patients when compared to the TEG-guided BCT group (14 ± 12 days, P < 0.05). TEG-guided BCT showed as an independent factor associated with hospital LOS after other variables were adjusted (coefficiency: 5.44, 95% confidence interval: 0.69 - 10.18).ConclusionsTraumatic abdominal solid organ injury patients receiving blood transfusions might benefit from TEG-guided BCT as indicated by less blood products needed and less hospitalization stay among the cohort.

Trends in nonoperative management of traumatic injuries – A synopsis

Nonoperative management of both blunt and penetrating injuries can be challenging. During the past three decades, there has been a major shift from operative to increasingly nonoperative management of traumatic injuries. Greater reliance on nonoperative, or “conservative” management of abdominal solid organ injuries is facilitated by the various sophisticated and highly accurate noninvasive imaging modalities at the trauma surgeon’s disposal. This review discusses selected topics in nonoperative management of both blunt and penetrating trauma. Potential complications and pitfalls of nonoperative management are discussed. Adjunctive interventional therapies used in treatment of nonoperative management-related complications are also discussed.Republished with permission from:Stawicki SPA. Trends in nonoperative management of traumatic injuries – A synopsis. OPUS 12 Scientist 2007;1(1):19-35.

Selective nonoperative management of abdominal gunshot wounds with isolated solid organ injury

ObjectiveTo review selective nonoperative management (SNOM) of gunshot wound (GSW) patients with isolated abdominal solid organ injury. MethodsPatients who sustained isolated solid organ injury secondary to GSW from 2003 to 2014 were studied. The use of SNOM over time was analyzed, and comparisons of initial SNOM and operative management (OM) groups were performed. ResultsOf 127 patients, 63 (50%) underwent SNOM. There were no significant differences between the early/late or SNOM/OM groups in demographics, physiologic presentation, or Injury Severity Score. SNOM increased from the early to late cohorts (31%–67%, p < 0.001), without any change in outcomes. SNOM patients had shorter hospital stays (5.8 vs. 10.0 days, p < 0.001), received fewer PRBCs (0.8 vs. 4 units, p < 0.001), and suffered fewer complications (13% vs. 28%, p < 0.05) than the OM group. ConclusionAn increase in SNOM vs. OM was associated with equivalent outcomes. Patients undergoing SNOM received fewer PRBCs and had shorter LOS.

New EFSUMB Statement on Paediatric CEUS

As most of you will be aware, the FDA in the United States took the unprecedented step of approving an ultrasound contrast agent (Lumason™ / SonoVue™) for use not only in the adult patient with a focal liver lesion but also in the paediatric population. Clinical trials for the adult patient were conducted in the United States but no such paediatric trial was performed, and in fact there has been no clinical trial anywhere in the world to address this issue. The decision of the FDA was based entirely on safety data provided by European centres, where CEUS in children has been performed for a number of years with success. Numerous European based studies have reported the usefulness of this technique in liver, and elsewhere particularly in the management of blunt abdominal trauma in the child. There is no justification to subject the child to repeat CT examinations when the CEUS examination is so accurate in isolated solid abdominal organ injury.

Management of Abdominal Solid Organ Injury After Blunt Trauma.

Injury to the solid abdominal organs-liver, spleen, kidney, and pancreas-is one of the most common injury patterns in pediatric blunt trauma. Pediatric trauma centers are becoming increasingly successful in managing these injuries without operative intervention. Well-validated guidelines have been established for liver and spleen injury management, and operative intervention is reserved for patients who show evidence of active bleeding after resuscitation. No such guidelines yet exist for the management of traumatic injury of the kidney or pancreas. Exploratory laparotomy remains the treatment of choice in patients suffering hemodynamic collapse, but interventional radiologic or endoscopic procedures are increasingly used to manage all but the most devastating solid organ injuries. [Pediatr Ann. 2016;45(7):e241-e246.].