Abdominal trauma

Abdominal trauma in children is relatively uncommon but may be associated with considerable morbidity and mortality. Further damage should be prevented by optimal evaluation of specific anatomic features that make the injured child more susceptible for solid organ injuries. The spleen is the most frequently injured intra-abdominal solid organ. The liver is the second most injured organ in children. The management of both spleen and liver injuries in children is predominantly non-operative; laparoscopy or laparotomy is only performed in hemodynamic unstable patients and in those with a hollow viscus perforation. Non-operative management of isolated spleen and liver injury in a pediatric trauma center can be successful in more than 95 % of cases. Pancreatic injuries are more difficult to diagnose on both CT scan and with laboratory findings. Treatment options vary by type of injury and surgeons’ preferences. Contusions are mostly treated non-operatively; pancreatic transections (grade III injuries) are treated operatively in some centers and nonoperatively in other centers. Endoscopic treatment has become first choice of treatment for pancreatic transections in a few centers provided the pediatric gastroenterologist has the required skills. Hollow viscus injury is the relatively rarest kind of injury. Its diagnosis is still a major challenge and is often delayed. Treatment is similar as to that in adults with the resection of the involved bowel and/or mesentery. Finally, penetrating abdominal trauma accounts for approximately 10 % of abdominal trauma in children and has a high mortality rate, particularly in the very young ones. In conclusion, abdominal trauma in children is rare and both nonoperative treatment and emergency surgical treatment should be adapted to the type of injury of the intra-abdominal organs involved.

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