The Diagnosis and Management of Pediatric Blunt Abdominal Trauma-A Comprehensive Review

Abstract

Blunt abdominal trauma in childhood has always been full of diagnostic and therapeutic challenges that have tested the clinical and radiological skills of pediatric surgeons and radiologists. Despite the guidelines and the studies carried out so far, to this day, there is no absolute consensus on certain points of view. Around the world, a paradigm shift towards non-operative treatment of hemodynamically stable children, with low complication rates, is noticeable. Children with blunt abdominal trauma require a standardized methodology to provide the best possible care with the best possible outcomes. This comprehensive review systematizes knowledge about all aspects of caring for children with blunt abdominal trauma, from pre-hospital to post-hospital care.

Keywords: blunt abdominal injury; blunt abdominal trauma; children; hollow viscus injuries; liver injury; pancreatic injury; pediatric surgery; spleen injury; urinary tract injuries.

Figure 1

CT with IV contrast shows free fluid around the liver and spleen (hemoperitoneum) with complete disruption of the spleen parenchyma in terms of rupture.

Figure 2

CT shows hematomas within the liver parenchyma, with rupture of the capsule and development of hemoperitoneum.

Figure 3

Pancreatic injury: (A) Post-contrast CT sections through the abdomen in the region of the omental bursa show a fluid collection corresponding to a hematoma of the omental bursa. (B) CT representation of pancreatic rupture.

Figure 4

External drainage of huge pancreatic pseudocyst: (A) Pseudocyst prior to drainage (8.3 × 6.1 cm); (B) CT-assisted extranal percutaneous drainage; (C) Complete resolution of the cyst after six weeks.

Figure 5

CT with intravenous contrast shows a laceration of the right kidney with perirenal hematoma.