The management of abdominal
trauma (particularly blunt
trauma) has undergone tremendous revolution in the last 30 years with significant reduction in morbidity and mortality in developed countries. The aim of this report is to highlight the challenges of managing abdominal
trauma in children in Nigeria based on our experience in Zaria, northern Nigeria.
METHOD: This is a retrospective review of 82 children managed for abdominal
trauma from 1991 2002 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information regarding demographics, mechanism of injury, haemodynamic status at presentation, clinical and radiologic evaluation, management, intraoperative findings and outcome, were extracted from case notes, operation notes and discharge summary notes.
RESULTS: Fifty seven (69.5%) children had blunt
trauma, mostly from traffic accidents (32, 57%) and falls (20, 36%), and 25 (30.5%) penetrating
trauma mainly from falls onto sharp objects (7 of 18 patients) and animal-related
injuries (5 of 18 patients). In the management of those with blunt
trauma, advanced imaging modalities were usually not available and this resulted in an unnecessary
laparotomy rate of 51% (
laparotomy considered unnecessary because the patients remained haemodynamically stable after
resuscitation and any intraperitoneal
bleeding had stopped by the time oflaparotomy and no active operative measure was required to control
bleeding). The management of penetrating
trauma was more straightforward as this was guided by evidence of peritoneal penetration. Mortality from blunt
trauma was 14.5% (8 of 55 patients) from exsanguinations before surgery 2, gastric perforation 3, hepatic
laceration 2 and splenic injury one. Mortality from penetrating
trauma was 12% (3 of 25 patients) from
tetanus, overwhelming
infection and haemorrhage respectively. The overall mortality from
abdominal injury was 13.8% (11 of 80 patients) and were mostly avoidable if the patients presented early, and received some
resuscitation before arrival at our hospital.
CONCLUSION: The management of blunt abdominal
trauma in children in Nigeria is faced with several challenges, which are mainly absence of an organised
trauma system and lack of appropriate facilities. These need to be addressed in order to improve the care of these
injuries.