Abdominal Trauma In Children Research Articles

Blunt abdominal trauma in children

This review will examine the current evidence regarding pediatric blunt abdominal trauma and the physical exam findings, laboratory values, and radiographic imaging associated with the diagnosis of intra-abdominal injuries (IAI), as well as review the current literature on pediatric hollow viscus injuries and emergency department disposition after diagnosis. The importance of the seat belt sign on physical examination and screening laboratory data remains controversial, although screening hepatic enzymes are recommended in the evaluation of nonaccidental trauma to identify occult abdominal organ injuries. Focused Assessment with Sonography for Trauma (FAST) has modest sensitivity for hemoperitoneum and IAI in the pediatric trauma patient. Patients with concern for undiagnosed IAI, including bowel injury, may be considered for hospital admission and serial abdominal exams without an increased risk of complications, if an exploratory laparotomy is not performed emergently. Although the FAST exam is not recommended as the sole screening tool to rule out IAI in hemodynamically stable trauma patients, it may be used in conjunction with the physical exam and laboratory findings to identify children at risk for IAI. Children with a normal physical exam and normal abdominal CT may not require routine hospitalization after blunt abdominal trauma.

Early laparoscopic repair for blunt duodenal perforation in an adolescent

Duodenal perforation secondary to blunt abdominal trauma in children is rare and usually associated with delays in diagnosis and surgical intervention. The authors encountered such a case in a 12-year-old boy owing to his falling over the handlebar of a bicycle. Imaging examination showed that there was a perforation over the fourth portion of the duodenum without concomitant injuries. Using a 5-port transperitoneal laparoscopic technique, primary closure of the perforation was successfully performed at 6 hours after the impact. Laparoscopic approach appears to be safe and feasible in hemodynamically stable children with solitary traumatic duodenal perforation if the operation can be performed early in the course of the incident.

Epidemiology of abusive abdominal trauma hospitalizations in United States children

Objectives(1) To estimate the incidence of abusive abdominal trauma (AAT) hospitalizations among US children age 0–9 years. (2) To identify demographic characteristics of children at highest risk for AAT. DesignSecondary data analysis of a cross-sectional, national hospitalization database. SettingHospitalization data from the 2003 and 2006 Kids’ Inpatient Database (KID). Main exposureFrequency and rate of hospitalizations for abusive abdominal trauma as identified by ICD-9CM codes for abdominal trauma and child abuse and E-codes for inflicted injury. Outcome measuresHospitalization rates by age, insurance status, and frequency of specific organ injury. ResultsAAT rates were higher for infants than for any other age group, with 17.7 (95% CI 11.7–23.9) cases per million in 2006. More than 25% of all abdominal trauma in children <1 year of age was abusive. For all age groups, rates were higher for males than females, and for children insured by Medicaid compared to those with private insurance. Organs most commonly injured were the liver (64% of hospitalizations), kidney (19%), and stomach/intestines (12%). ConclusionsAlthough experts have considered toddlers to be at highest risk for AAT, infants have higher rates of AAT hospitalization. Similar to other abusive injuries, young age, male gender, and poverty are risk factors for AAT.

Isolated Gallbladder Perforation After Blunt Abdominal Trauma In Children: A Case Report.

Injury of the gallbladder after blunt abdominal trauma is rare. Isolated contusion of the gallbladder is exceptional because of its anatomical localization. It is protected by the liver, intestines, the omentum and ribs. Its clinical presentation is often insidious, the reason why the diagnosis is often made during an exploring laparotomy. The delayed diagnosis is often responsible of high morbidity and mortality. Early diagnosis is thus essential but still remains a challenge. We report a case of isolated perforation of the gallbladder after blunt abdominal trauma in a 15 years old boy found at the stage of generalized peritonitis. The exploratory laparotomy leads to diagnosis and treating the lesion by cholecystectomy.

Adrenal injuries following blunt abdominal trauma in children: Report of two cases

Adrenal injuries following blunt abdominal trauma are uncommon. Adrenal hemorrhage in children associated with multiple organ injury, which has received little attention in the past, is an increasingly recognized phenomenon in modern trauma centers with the widespread use of abdominal computed tomography. Adrenal trauma occurs in the setting of multisystem organ injury. Isolated adrenal injury is exceedingly rare. We report two children with blunt adrenal trauma (one isolated and one with associated injuries), who were admitted during the last two years to our Pediatric Surgery Department after abdominal trauma. We determined the prevalence, management and general prognosis of blunt adrenal injury in the pediatric population. Traumatic adrenal hemorrhage appears to be an incidental and unsuspected finding that resolves on follow-up imaging.

Intramural duodenal hematoma after upper gastrointestinal endoscopy

Intramural hematoma of the duodenum is a very rare condition. It is mostly seen after blunt abdominal trauma in children. There are only few cases of intramural duodenal hematoma after upper gastrointestinal endoscopy. Most of them are associated with coagulation disorders. The optimal treatment strategy for this condition is still under debate. We present the case of a 21-year-old woman who had undergone an upper gastrointestinal endoscopy for dyspepsia and protracted singultus. Work-up included biopsies. Immediately after the procedure, the patient developed an intramural hematoma causing complete duodenal obstruction. The patient was treated conservatively and recovered within three weeks without any sequelae. Uncomplicated cases of intramural hematoma may be treated conservatively with total parenteral nutrition, fluid and electrolyte replacement.

Agent–host–environment model of blunt abdominal trauma in children

Background/Purpose Among children aged from 1 to 14 years, approximately 50% of mortality is related to trauma. Abdominal injuries account for approximately 10% of trauma deaths in childhood. Child injury has great effects on communities and countries. The agent–host– environment model has been used to describe the epidemiology of communicable diseases. It can be adapted for understanding childhood injuries. This study aims to evaluate the Zagazig University experience with blunt abdominal trauma (BAT) in children in light of the epidemiological (agent–host–environment) model. Patients and methods This study included 590 consecutive patients aged from 1 to 14 years, who were admitted to the Emergency Unit at the Zagazig University Hospital, after BAT incidents in the period January 2006–2010. A predesigned format was used to collect targeted data. Results The study included 590 children with BAT. They made up approximately 18% of total children trauma cases. Multisystem trauma occurred in 72.5% of patients. The causative energy in this study was mechanical energy that was most commonly transmitted through road traffic accidents (55.8%). When mechanisms of trauma were related to age groups, we found that road traffic accidents were significantly more common among children aged from 5 to 14 years (P value < 0.001), whereas falls were significantly more common among children aged from 1 to 4 years (P value < 0.001). The most common physical environment was streets. BAT was more in urban areas (65%) and in low socioeconomic states (67%). Conclusion According to this study, most BAT vulnerable children are boys aged from 5 to 14 years, living in urban areas, and with low socioeconomic status. The agent– host–environment model can be used to study causative and contributing factors to trauma. It can be utilized to structure and plan preventive interventions against BAT in children. Keywords: abdominal trauma, agent–host–environment model, blunt trauma, epidemiological model

Screening for Occult Abdominal Trauma in Children With Suspected Physical Abuse

Screening for Occult Abdominal Trauma in Children With Suspected Physical Abuse

CT identification of abdominal injuries in abused pre-school-age children

Although the abdominopelvic CT findings of abdominal trauma in children have been described, little has been written about the subset of children who are victims of abuse. Our purpose is to describe abdominopelvic injuries in abused pre-school-age children as identified on CT. An IRB-approved retrospective review of our institutional child abuse registry was performed. Searching a 14-year period, we identified 84 children ≤ 5 years of age with medically diagnosed abuse who underwent CT. We reviewed imaging studies, operative reports, autopsy findings and patient outcomes. Consensus review of the CT examinations was performed by CAQ-certified pediatric radiologists, and findings were categorized as normal or by injury types (solid organ versus bowel). The injuries were analyzed in light of existing literature on pediatric accidental and non-accidental injuries. Of the 84 children, 35 (41.7%) had abdominal injuries. Abdominal injuries included liver (15), bowel (13), mesentery (4), spleen (6), kidneys (7), pancreas (4) and adrenal glands (3). Of these children, 26% (9/35) required surgical intervention for bowel, mesenteric and pancreatic injuries. Another 9/35 children died, not as a result of abdominal injuries but as a direct result of inflicted intracranial injuries. Our data indicate that abdominal injuries in abused children present in a pattern similar to that of children with accidental abdominal trauma, underscoring the need for vigilance and correlative historical and clinical data to identify victims of abuse. Mortality in abused children with intra-abdominal injury was frequently related to concomitant head injury.

Penetrating Abdominal Trauma in Children

Penetrating abdominal trauma is an acute life-threatening emergency. The challenges of emergency department management are compounded in the pediatric population. This article focuses on the pediatric patient suffering from penetrating abdominal trauma, the importance of rapid diagnosis and treatment of shock, as well as the workup and definitive management of children with penetrating abdominal injuries.

Screening for occult abdominal trauma in children with suspected physical abuse

Child: Care, Health and DevelopmentVolume 36, Issue 3 p. 446-447 Screening for occult abdominal trauma in children with suspected physical abuse Richard Reading, Search for more papers by this author Richard Reading, Search for more papers by this author First published: 09 April 2010 https://doi.org/10.1111/j.1365-2214.2010.01090_5.xRead the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onEmailFacebookTwitterLinked InRedditWechat Volume36, Issue3May 2010Pages 446-447 RelatedInformation

Subtle Radiological Features of Splenic Avulsion following Abdominal Trauma

Splenic trauma in children following blunt abdominal injury is usually treated by nonoperative management (NOM). Splenectomy following abdominal trauma is rare in children. NOM is successful as in the majority of instances the injury to the spleen is contained within its capsule or a localised haematoma. Rarely, the spleen may suffer from an avulsion injury that causes severe uncontrollable bleeding and necessitates an emergency laparotomy and splenectomy. We report two cases of children requiring splenectomy following severe blunt abdominal injury. In both instances emergency laparotomy was undertaken for uncontrollable bleeding despite resuscitation. The operating team was unaware of the precise source of bleeding preoperatively. Retrospective review of the computed tomography (CT) scans revealed subtle radiological features that indicate splenic avulsion. We wish to highlight these radiological features of splenic avulsion as they can help to focus management decisions regarding the need/timing for a laparotomy following blunt abdominal trauma in children.

Screening for Occult Abdominal Trauma in Children With Suspected Physical Abuse

The goals were (1) to determine the prevalence of occult abdominal trauma (OAT) in a sample of children with suspected physical abuse, (2) to assess the frequency of OAT screening, and (3) to assess factors associated with screening. Charts of children evaluated for abusive injury were identified through a search of hospital discharge codes. Identified charts were reviewed to determine whether OAT screening occurred. Data on results of screening tests, abusive injuries identified, family demographic features, and characteristics of the emergency department visit were collected. Screening occurred for 51 (20%) of 244 eligible children. Positive results were identified for 41% of those screened and 9% of the total sample; 5% of children 12 to 23 months of age had OAT identified through imaging studies. Screening occurred more often in children presenting with probable abusive head trauma (odds ratio [OR]: 20.4 [95% confidence interval [CI]: 3.6-114.6]; P < .01), compared with those presenting with other injuries. Consultation with the child protection team (OR: 8.5 [95% CI: 3.5-20.7]; P < .01) and other subspecialists (OR: 24.3 [95% CI: 7.1-83.3]; P < .01) also increased the likelihood that OAT screening would occur. Our findings support OAT screening with liver and pancreatic enzyme measurements for physically abused children. This study also supports the importance of subspecialty input, especially that of a child protection team. Although many identified injuries may not require treatment, their role in confirming or demonstrating increased severity of maltreatment may be critical.

Challenges of managing paediatric abdominal trauma in a Nigerian setting.

The management of abdominal trauma (particularly blunt trauma) has undergone tremendous revolution in the last 30 years with significant reduction in morbidity and mortality in developed countries. The aim of this report is to highlight the challenges of managing abdominal trauma in children in Nigeria based on our experience in Zaria, northern Nigeria. This is a retrospective review of 82 children managed for abdominal trauma from 1991 2002 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information regarding demographics, mechanism of injury, haemodynamic status at presentation, clinical and radiologic evaluation, management, intraoperative findings and outcome, were extracted from case notes, operation notes and discharge summary notes. Fifty seven (69.5%) children had blunt trauma, mostly from traffic accidents (32, 57%) and falls (20, 36%), and 25 (30.5%) penetrating trauma mainly from falls onto sharp objects (7 of 18 patients) and animal-related injuries (5 of 18 patients). In the management of those with blunt trauma, advanced imaging modalities were usually not available and this resulted in an unnecessary laparotomy rate of 51% (laparotomy considered unnecessary because the patients remained haemodynamically stable after resuscitation and any intraperitoneal bleeding had stopped by the time oflaparotomy and no active operative measure was required to control bleeding). The management of penetrating trauma was more straightforward as this was guided by evidence of peritoneal penetration. Mortality from blunt trauma was 14.5% (8 of 55 patients) from exsanguinations before surgery 2, gastric perforation 3, hepatic laceration 2 and splenic injury one. Mortality from penetrating trauma was 12% (3 of 25 patients) from tetanus, overwhelming infection and haemorrhage respectively. The overall mortality from abdominal injury was 13.8% (11 of 80 patients) and were mostly avoidable if the patients presented early, and received some resuscitation before arrival at our hospital. The management of blunt abdominal trauma in children in Nigeria is faced with several challenges, which are mainly absence of an organised trauma system and lack of appropriate facilities. These need to be addressed in order to improve the care of these injuries.

Blunt abdominal trauma in children: how predictive is ALT for liver injury?

Background:The liver is the second most commonly injured intra-abdominal organ in children. CT scanning is currently regarded as the “gold standard” in screening for intra-abdominal injury following blunt trauma. However,...

Blunt Abdominal Trauma in Children: A Score to Predict the Absence of Organ Injury

To evaluate the initial workup and design a score that would allow ruling out significant intra-abdominal organ injuries following blunt abdominal traumas (BAT). Data were collected prospectively from 147 consecutive patients admitted for BAT in a tertiary care hospital, over a 30-month period. Statistical significance of various parameters (trauma mechanism, clinical examination, laboratory tests, and ultrasound findings) were analyzed in relation to intra-abdominal injuries. The 10 parameters with the best negative predictive values (NPV) were then used to build a score (BATiC). The following points were attributed for these items: abnormal abdominal Doppler ultrasound (4 points), abdominal pain (2 points), peritoneal irritation (2 points), hemodynamic instability (2 points), aspartate aminotransferase >60 IU/L (2 points), alanine aminotransferase >25 IU/L (2 points), white blood cell count >9.5 g/L (1 point), LDH >330 IU/L (1 point), lipase >30 IU/L (1 point), and creatinine >50 microg/L (1 point). A score of < or = 7 has a NPV of 97% and includes 67% of the studied population. These results suggest that in hemodynamically stable patients with a normal abdominal Doppler ultrasound and a BATiC score of < or = 7, intra-abdominal lesions are very unlikely, and systematic CT scan or hospital admission may be avoided.

Management of Abdominal Trauma in Children

Management of Abdominal Trauma in Children

Proximal Splenic Artery Pseudoaneurysm after Radical Subtotal Gastrectomy

Splenic artery pseudoaneurysm (SAP) is a very rare case, postoperatively. SAP originates from many causes such as complication of chronic pancreatitis in adults and blunt abdominal trauma in children. SAP related to surgery may result from direct tissue injury during operation. Urgent angiography is helpful in diagnoses and life-saving procedures as the endovascular embolization simultaneously. However, endovascular management is not a definite treatment modality in patients previously operated on because the blood supply of remaining organs will be insufficient after embolization. In this paper, we report a rare case that is proximal splenic artery pseudoaneurysm after radical subtotal gastrectomy in a 63-year-old male patient with early gastric cancer, as well as a brief review.

Blunt abdominal trauma in children: a score to predict the absence of organ injury

Blunt abdominal traumas (BAT) are frequent and potentially life-threatening events in children. The aim of this study was to evaluate the initial workup, and to design a score that would allow ruling out significant intra-abdominal organ injuries.

Imaging utilization commentary: a radiology perspective

To adhere to the ALARA concept, imaging should be limited to studies that actually contribute to the management of the patient. For example, by applying the Ottawa Ankle Rule and the Ottawa Knee Rule, fewer radiographs are required to evaluate ankle and knee trauma in children. Chest radiographs usually do not contribute to the management of children presenting with typical acute bronchiolitis or asthma, and they can be detrimental because consolidation resulting from retained secretions is interpreted as pneumonia and the child is started on antibiotics unnecessarily. Moreover, a radiograph of the abdomen has poor validity and reproducibility for the diagnosis of constipation. The Pediatric Emergency Care Applied Research Network (PECARN) and the Pediatric Emergency Research in Canada (PERC) are currently developing decision rules for the use of CT in the assessment of minor head injuries in children, which should reduce its utilization in this condition. PECARN is also developing a decision rule for the use of CT in the assessment of abdominal trauma in children. CT is frequently used for the diagnosis of appendicitis in children, but appendicitis can be diagnosed clinically. If imaging is required, appendicitis can often be diagnosed with US, and CT need only be used in the minority of cases where the diagnosis is still in doubt. Utilization guidelines for pediatric imaging studies obtained in children in the emergency setting can improve yield and help in the more efficient management of often scarce health care resources.