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Intra-Abdominal Solid Organ Injury in Children: Diagnosis and Treatment

Gaines, Barbara A. MD

Journal of Trauma-Injury Infection & Critical Care: August 2009 - Volume 67 - Issue 2 - pp S135-S139
doi: 10.1097/TA.0b013e3181adc17a
Original Article

Objectives: Abdominal trauma is relatively uncommon in children but can be the source of significant morbidity and mortality. The diagnosis and treatment of blunt abdominal injury to the solid organs were examined, and the differences between children and adults were highlighted.

Methods: The PubMed database was used to identify the relevant literature. Additional source material was identified through referenced articles.

Results: Identification of injury to the solid organs in children depends on a high index of suspicion, abnormal physical examination findings, and the judicious use of laboratory and imaging studies. Although abdominal and pelvic computed tomography with intravenous contrast remains the gold standard for imaging, it does expose children to a significant dose of radiation. Currently, more than 90% of solid organ injuries in children are treated nonoperatively. Abnormal hemodynamics, however, suggests active bleeding and requires operative intervention. Accurate diagnosis of the organ injured and degree of injury are important considerations for “return to play” decisions. The management of pancreatic ductal injuries is somewhat controversial, although the distal spleen preserving pancreatectomy is frequently the technique of choice.

Conclusions: Pediatric intra-abdominal solid organ injury is relatively uncommon, but a potential source of significant morbidity. Non-operative management is the standard of care for the majority of these injuries, although continued hemodynamic instability mandates operative intervention.

From the Department of Surgery, Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania.

Submitted for publication October 16, 2008.

Accepted for publication May 9, 2009.

Address for reprints: Barbara A. Gaines, MD, Children’s Hospital Drive, 45th and Penn Avenue, Pittsburgh, PA 15201; email: barbara.gaines@chp.edu.

© 2009 Lippincott Williams & Wilkins, Inc.