Blunt Abdominal Trauma In Childhood Research Articles

Paediatric blunt abdominal trauma - are we doing too many computed tomography scans?

Blunt abdominal trauma in childhood contributes significantly to both morbidity and mortality. Selective non-operative management of blunt abdominal trauma in children depends on both diagnostic and clinical factors. Computed tomography (CT) scanning is widely used to facilitate better management. Increased availability of CT may, however, result in its overuse in the management of blunt abdominal trauma in children, which carries significant radiation exposure risks. To evaluate the use and value of CT scanning in the overall management and outcome of blunt abdominal trauma in children in the Tygerberg Academic Hospital trauma unit, Parow, Cape Town, South Africa, before and after improved access to CT as a result of installation of a new rapid CT scanner in the trauma management area (previously the scanner had been 4 floors away). Patients aged 0 - 13 years who were referred with blunt abdominal trauma due to vehicle-related accidents before the introduction of the new CT scanner (group 1, n=66, November 2003 - March 2009) were compared with those seen in the 1-year period after the scanner was installed (group 2, n=37, April 2009 - April 2010). Details of clinical presentation, imaging results and their influence on management were retrospectively reviewed. A follow-up group was evaluated after stricter criteria for abdominal CT scanning (viz. prior evaluation by paediatric surgical personnel) were introduced (group 3, n=14, November 2011 - May 2012) to evaluate the impact of this clinical screening on the rate of negative scans. There were 66 patients in group 1 and 37 in group 2. An apparent increase in CT use with increased availability was accompanied by a marked increase in negative CT scans (38.9% compared with 6.2%; p<0.006). Despite a slightly higher prevalence of associated injuries in group 2, as well as a slightly longer length of hospital stay, there was a similar prevalence of intra-abdominal injuries detected in positive scans in the two groups. In addition, rates of small-bowel perforation in the two groups were similar. The rate of negative scans in group 3 was 46.2% (6/13), but all except one of these patients had a severe brain injury preventing adequate clinical evaluation of intra-abdominal injury. CT scanning for blunt abdominal trauma in children is essential in the presence of appropriate clinical indications. Ease of access probably increases availability, but the rate of negative scans may increase. Management guidelines should be in place to direct CT scanning to cases in which clinical examination and/or other modalities indicate a likelihood of intra-abdominal injury. The principle of 'as low (radiation) dose as reasonably achievable' (ALARA) should be adhered to because of the increased radiation exposure risks in children.

Clinical Analysis of Blunt Abdominal Trauma in Childhood

Clinical Analysis of Blunt Abdominal Trauma in Childhood

Ultrasound diagnosis following blunt abdominal injury in childhood

In blunt abdominal trauma in childhood, sonography should be the primary method for diagnostic imaging. This simple and non-invasive investigation can be readily performed even in cases with severe traumatic organ lesions. In cases not requiring immediate surgery the method can be used for monitoring and follow-up. Other diagnostic procedures such as IVP, CT, abdominal plain x-ray, angiography, scintigraphy do not become superfluous but should be used according to the clinical and sonographic findings.

Pancreatic Injury from Blunt Abdominal Trauma in Childhood

Background : Pancreatic trauma in children is relatively uncommon, but carries high morbidity and mortality rates when diagnosis is delayed. Preoperative diagnosis of pancreatic lesion might be difficult, especially in the case of isolated injury.Methodology : Authors analyse seven cases of pancreatic trauma in childhood. In three cases surgical intervention was required due to pancreatic transection with main pancreatic duct rupture. The injuries of the 5–10 years old male patients were diagnosed and operated on within 24 hours.Results : In two cases distal resection were performed with splenic preservation. In one case-where the operation was performed within 8 hours-preservation of the distal pancreas was also achieved by distal pancreatogastrostomy. The postoperative period was uneventful in all cases. Impaired glucose metabolism was not found in the operated cases during the follow up.Conclusions : Authors emphasise the importance of CT scan and the responsibility of the first attending physician regarding both diagnosis and correct surgical management.

Isolated bowel injury in blunt abdominal trauma in childhood.

From a total of 734 children with a blunt abdominal trauma admitted to the hospital in the past 15 years, 21 patients (3%) sustained an isolated injury of the bowel (8 duodenal, 9 jejunal and 4 colon ruptures). All patients were laparotomized without a postoperative mortality. Accompanying abdominal injuries were seen only in duodenal ruptures (pancreatitis and one choledochal and pancreatic ruptures). In 85% the blunt violence was caused by bicycle accidents due to the handle bar, in one case by a car accident and in 3 children by falls. Accurate diagnosis was only possible regarding the history, the mechanism of the accident and an exact repeated clinical examination. Despite further investigations of blood chemistry laboratory findings, ultrasound and x-ray, no further confirmation of the diagnosis could be achieved. Complications, occurring in 14% of our patients, were not related to the trauma itself, but caused by a delayed diagnosis and therapy.

Significance of Bowel Wall Enhancement on CT Following Blunt Abdominal Trauma in Childhood

Over a 3-year period, 12 children with blunt abdominal trauma were noted to have intense bowel wall enhancement (BWE) on CT. In four, with fatal CNS injury, there was no evidence of bowel perforation, and the changes may be related to the hypovolemic complex. In the remaining eight patients with a gastrointestinal perforation, BWE was associated with the presence of diffuse or focal bowel wall thickening and free peritoneal fluid. The enhancement and thickening were due to peritonitis secondary to perforation as shown at operation or autopsy. In three further patients with bowel perforation, thickening and enhancement were absent in two with retroperitoneal perforation and thickening, and no enhancement was noted in one patient in whom the study was considered suboptimal in retrospect. Intense BWE, therefore, aids in the diagnosis of the hypovolemic complex: CNS injury and bowel perforation. When combined with bowel thickening and free fluid, perforation and peritonitis should be strongly suggested. Enhancement and thickening should suggest perforation even if other visceral injury is present to account for the free fluid. Surgical intervention should thus be more strongly considered when bowel wall thickening accompanies BWE.

CT of blunt abdominal trauma in childhood: P. E. Berger and J. P. Kuhn. Am J Roentgenol 136:105–110, (January), 1981

CT of blunt abdominal trauma in childhood: P. E. Berger and J. P. Kuhn. Am J Roentgenol 136:105–110, (January), 1981

CT of blunt abdominal trauma in childhood.

Computed tomography (CT) was performed on 23 children who had sustained moderate or severe blunt abdominal trauma. The major advantages of CT over excretory urography, sonography, and radionuclide imaging include superior anatomic detail and ability to visualize all organs, the peritoneal cavity, and retroperitoneum simultaneously. In suspected renal injury, CT best defines the extent of parenchymal injury and provides an easy method for accurate follow-up when conservative management is elected. Angiography is necessary for direct demonstration of vascular injury, for demonstration of active bleeding, and in therapeutic embolization of active bleeding sites. CT seems well suited to evaluation of the liver and retroperitoneum. Evaluation of the spleen has been satisfactory, but may be less accurate because of potential pitfalls. Duodenal hematomas are best evaluated by the upper gastrointestinal series. For CT scanning of the traumatized child to be of maximum value, intravenous contrast enhancement and meticulous attention to technique is necessary.

Rupture of the common hepatic duct after blunt abdominal trauma in childhood: G. Defant and F. Pisoni. Rass Ital Chir Ped 18:56–65 (October–December), 1976

Rupture of the common hepatic duct after blunt abdominal trauma in childhood: G. Defant and F. Pisoni. Rass Ital Chir Ped 18:56–65 (October–December), 1976

Blunt Abdominal Trauma in Childhood

Blunt abdominal trauma in childhood is a common clinical occurrence. Accurate assessment requires an understanding of patterns of injury and the response of the child. Repetitive examinations in a comforting environment will yield superior clinical judgment. Renal trauma is frequent, requires thorough radiologic evaluation, and may be associated with an underlying anomaly. The goal of management is salvage of functioning nephrons. Definitive indications should exist prior to operative intervention. The goal of management of splenic injury should not be the justification of splenectomy. The operative decision should be based on clinical indications. Judgment should include a knowledge of the risks and alternatives.