Hollow viscus blunt abdominal trauma in children
- Haley Guzzo, MD
Haley Guzzo, MD
- Johns Hopkins Department of Anesthesiology and Critical Care Medicine
- William Middlesworth, MD, FAAP, FACS
William Middlesworth, MD, FAAP, FACS
- Assistant Professor of Surgery and Pediatrics
- Columbia University College of Physicians & Surgeons
- Section Editor
- Susan B Torrey, MD
Susan B Torrey, MD
- Section Editor — Pediatric Resuscitation; Pediatric Trauma
- Director, Division of Pediatric Emergency Medicine
- Associate Professor of Emergency Medicine and Pediatrics (Clinical)
- NYU School of Medicine
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — Adult and Pediatric Emergency Medicine
- Senior Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Hollow viscus injuries in children resulting from blunt abdominal trauma are usually inflicted by forceful mechanisms that cause serious associated injuries. The diagnosis of hollow viscus injury may be delayed, since the more obvious solid visceral injuries that frequently accompany them are managed nonoperatively, and imaging studies (specifically computed tomographic [CT] scan), when performed soon after the injury, may fail to demonstrate them. Definitive management of children with blunt abdominal trauma who are evaluated for hollow viscus injury depends on clinical findings. Most require surgical intervention.
This topic will review blunt hollow visceral injuries in children, including mesenteric injury, duodenal hematoma, and perforation of the stomach, small intestine, and colon. Evaluation and management of traumatic liver, pancreas, and splenic injuries in children are discussed separately. (See "Liver, spleen, and pancreas injury in children with blunt abdominal trauma".)
In addition, bowel injuries associated with rectal foreign bodies are reviewed elsewhere. (See "Rectal foreign bodies", section on 'Complications'.)
Blunt abdominal trauma occurs frequently in childhood but seldom results in significant hollow visceral injury. The overall frequency of blunt hollow visceral injuries among children in the United States ranges from <1 to 5 percent in large reviews of pediatric blunt abdominal trauma [1-6]. Injury to the small bowel (specifically jejunal perforation) is seen most commonly, followed by injury to the duodenum, colon, and stomach [1-3].
The majority of gastrointestinal (GI) injuries are caused through a discrete point of energy transfer (eg, direct blow, seat belt injury, bicycle handlebar injury) . Motor vehicle accidents are the most prevalent cause in reviews from pediatric trauma centers [2,4,7-12]. Falls and bicycle handlebar injuries are other frequent causes [3,4,7-9,11].
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- Child abuse
- Seat belt syndrome
- ANATOMIC ASPECTS OF SPECIFIC INJURIES
- Small intestine
- Pool suction entrapment and evisceration
- Initial assessment
- Physical examination
- Ancillary studies
- - Laboratory studies
- - Imaging
- - Diagnostic peritoneal lavage
- Child protection
- OPERATIVE MANAGEMENT
- Time to surgical intervention
- SUMMARY AND RECOMMENDATIONS