The diagnosis and treatment of abdominal trauma in children / 中国小儿急救医学

ABSTRACT

Objective To explore the indications of conservative treatment and to explore the laparotomy for children with abdominal trauma,so as to improve the diagnosis and treatment of abdominal injury in children.Methods This retrospective review included 89 children who had an abdominal trauma which was classified according to the injury situation.Results (1)Of 25 patients with hepatic injury,1 underwent surgery.Among the 48 patients with splenic injury,46 cases were treated successfully by conservative treatment,only 1 underwent splenectomy and another adopted splenic neoplasty.Fourteen patients suffered from gastrointestinal injury,and 4 of them underwent emergency laparotomy,however a delayed perforation of digestive tract occurred in 1 child when he was in hospital 4 days later.Eight cases of pancreatic trauma were treated successfully by conservative treatment,the same as 6 cases of renal and adrenal contusion.One child with uterus and bladder injury was atopted emergency surgical treatment.(2) Unlike adults,conservative management of hepatic and splenic injuries was successfully applied to the vast majority of children.Operative treatment ought to be carried out when hemodynamic stability could not be maintained despite a continuous intravenous fluids and blood transfusion,or when the total amount of blood transfusion exceeds 40 ml/kg.(3)CT was very useful for children with gastrointestinal injury,especially for one cannot stand for abdominal X-ray examination.Operative treatment ought to be carried out timely in those with pneumoperitoneum or abdominal distension.We should pay particular attention to the possibility of delayed perforation.(4)In general,pancreatic injury could be treated conservatively except the ones with pancreatic rupture.(5)Children with bladder and uterine injury often suffered from severe trauma,and needed to be operated timely.Conclusion Children with abdominal injury should be highly valued in primary hospital.Internal bleeding caused by substantial organ injury is the leading cause of death in children,and the delayed diagnosis and treatment of the injured cavity organs is another important cause of the death.Therefore,early accurate diagnosis,active treatment,comprehensive treatment of severe combined injuries and complications are the key to successful treatment of such patients.