In developed countries, the availability of advanced imaging techniques has reduced the necessity for
laparotomy following blunt abdominal
trauma in children.
Laparotomy rates still remain high in developing countries where these advanced imaging techniques are lacking. A simple management protocol to identify patients who require
laparotomy could reduce the
laparotomy rate in children with blunt abdominal
trauma in these countries.
PATIENTS/METHODS: This is a review of children aged 15 years or below managed in our institution over a 5 1/2-year period for blunt abdominal
trauma. The children were divided into two groups. Group A consisted of children managed from January 1999 - December 2000. During this period, there was no protocol. Group B consisted of children managed from January 2001 - June 2004. During this period, a simple management protocol was introduced. The
laparotomy rates in the two groups were analysed using a simple chi-square.
RESULTS: A total of 48 children, representing 63 % of children with abdominal
trauma during the study period, were examined (Group
A 17; Group
B 31). Their ages ranged from 1.5 years - 15 years (median 9 years). Thirty-four were boys, 14 were girls (M:F = 2.4:1). Road traffic accidents accounted for 38 (79.1 %) and falls from heights for 9 cases (18.75 %), and one boy with a hydronephrotic kidney fell off the staircase at home. The diagnosis was clinical, supported by abdominal ultrasound scan (USS) and plain abdominal film. Twenty-eight (58.3 %) children had
laparotomy (15 in Group A; 13 in Group B). There was a statistically significant difference in the
laparotomy rates between Group A and B (p < 0.01). Nineteen children were managed nonoperatively (2 in Group
A; 17 in Group B); one child died before an operation could be performed. There were 59 abdominal organ
injuries in 45 children. In 2 children, ultrasound could not diagnose any organ injury. There were 33 splenic
injuries; 15 children had splenic conservation, 7 underwent a
splenectomy, while 10 were managed nonoperatively. One child with splenic injury died before operation. Of 7 liver
injuries, 4 required suturing of
lacerations, 1 subcapsular haematoma was left undisturbed at
laparotomy, while 2 were managed nonoperatively. There were 4 pancreatic
injuries. Three were managed nonoperatively, while 1 associated with duodenal injury had a
laparotomy. All 6 gastrointestinal
injuries had
laparotomy. There were 5 renal
injuries: 3 had
laparotomy with suturing, while 2 were managed nonoperatively. There were 4 bladder
injuries: 2 had
laparotomy with suprapubic
catheter insertion, while 2 were managed nonoperatively. There were 7 retroperitoneal haematomas in association with other organ
injuries. Associated
injuries included
head injury in 2, long
bone fracture in 2,
spinal injury and chest
trauma in 1 each. There were 4 deaths, 1 before surgery could be performed.
CONCLUSION: