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Hollow viscus blunt abdominal trauma in children

Authors
Haley Guzzo, MD
William Middlesworth, MD, FAAP, FACS
Section Editor
Susan B Torrey, MD
Deputy Editor
James F Wiley, II, MD, MPH

INTRODUCTION

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'.)

EPIDEMIOLOGY

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) [3]. 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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Literature review current through: Nov 2016. | This topic last updated: Thu Aug 11 00:00:00 GMT+00:00 2016.
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