[Contusions of the abdomen in children]

Abstract

Marked progress in the treatment of abdominal contusions in children over the last few years is due to the development of conservative surgery to the spleen and even possible abstention from operation following splenic injuries. The reliability of paraclinical exploratory procedures has increased, and ultrasound and CT scan imaging have reduced the need for peritoneal puncture-lavage. However, and unresolved problem concerns associated visceral lesions, and although treatment of isolated splenic injuries is fairly well detailed that of hepatic lesions raises difficulties because of lack of data on exact location of lesions and the anatomical damage produced. Injuries provoked and treatment instituted are described in relation to children admitted for severe abdominal contusions between 1970 and 1985. Since 1984, 52 children have undergone initial ultrasound imaging and only 6 (8%) peritoneal puncture-lavage procedures were necessary. Ultrasound is of value for diagnosis of a hemoperitoneum but of very limited use for defining sites of lesions, a more refined diagnosis being established by computed tomography. Finally, routine simplified emergency intravenous urography is performed in any child with severe abdominal contusion with even microscopic hematuria to detect possible subadventitial rupture of renal artery.