Management outcomes in blunt abdominal trauma in children: [a prospective study]

ABSTRACT

Clinical pathways now highlight both observation and operation as acceptable initial therapeutic options for management of blunt abdominal trauma in children. The purpose of this study was to evaluate treatment trends and end results of blunt abdominal trauma in children. Sixity child were admitted to trauma and emergency department of Sohag university hospital in the period from October 1998 To March 2000. The age ranged from 1 To 14 years old [42 male, 18 female]. According to clinical examination and radiological investigations, patients were classified into two groups the first group [40 cases] was subjected to abdominal exploration and the second group [20 cases] was subjected to non-operative treatment. The first group splenectomy was done for 21 cases [15 cases of grade 5, 6 cases of grade 4 splenic injury]. Hepatic tear was found in 4 cases, where suturing was done in 2 cases while homeostatic agents were applied in 2 cases. Biliary injury was found in 2 cases and intestinal injury was found in 13 cases. The second group the non-operative management was successful in 9 out of 12 cases with grade 1, 2 and 3 of splenic trauma [75% success rate] while it was successful in 6 out of 8 cases of hepatic trauma [75% success rate]. The operative management was mandatory in blunt abdominal trauma in children if there was haemodynamic unstability or positive diagnosis of haemoperitoneum by one of different methods of investigation. The conservative management was successful in splenic injuries using the criteria of AAST [American Association for the Surgery of Trauma] if there was haemodynamic stability plus absence of other associated abdominal injury. It was also successful in hepatic injuries in specific conditions