Overview of blunt abdominal trauma in children
- Donna Reyes Mendez, MD
Donna Reyes Mendez, MD
- Associate Professor of Emergency Medicine
- University of Texas Health Science Center (UTHSC) Medical School Houston
- Section Editors
- Richard G Bachur, MD
Richard G Bachur, MD
- Section Editor — Pediatric Trauma
- Professor of Pediatrics and Emergency Medicine
- Harvard Medical School
- George A Woodward, MD
George A Woodward, MD
- Section Editor — Pediatric Signs and Symptoms
- Professor of Pediatrics
- University of Washington 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
The evaluation and management of children with blunt abdominal trauma will be reviewed here. The assessment and treatment of children with specific injuries to the spleen, liver, pancreas, or gastrointestinal tract are discussed separately. (See "Hollow viscus blunt abdominal trauma in children" and "Liver, spleen, and pancreas injury in children with blunt abdominal trauma".)
Children are more vulnerable to blunt abdominal injury than adults for the following reasons (see "Trauma management: Unique pediatric considerations", section on 'Abdomen'):
●Relatively compact torsos with smaller anterior-posterior diameters, which provide a smaller area over which the force of injury can be dissipated.
●Larger viscera, especially liver and spleen, which extend below the costal margin
●Less overlying fat, and weaker abdominal musculature to cushion intraabdominal structures
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- Physical examination
- - Abdomen
- Seat belt sign
- - Associated injuries
- Laboratory evaluation
- - Approach
- - Specific tests
- Hemoglobin and hematocrit
- Blood type and crossmatch
- Liver transaminases
- Pancreatic enzymes
- Other testing
- Radiologic evaluation
- - Abdominal and pelvic CT
- Use of contrast
- Low-risk rule for intraabdominal injury
- - Ultrasonography
- - Plain radiographs
- Peritoneal lavage
- DEFINITIVE MANAGEMENT
- Nonoperative management
- SPECIFIC INJURIES
- Liver, spleen, or pancreas injury
- Gastrointestinal (GI) tract
- SUMMARY AND RECOMMENDATIONS