News & Perspective
Drugs & Diseases
CME & Education
Video
Decision Point
Edition: English

Medscape

English
Deutsch
Español
Français
Português
UKNew

Univadis

Sign Up It's Free!
English Edition

Medscape

Univadis

    X
    Univadis from Medscape

    No Results

      News & Perspective Drugs & Diseases CME & Education Video Decision Point
      Drugs & Diseases > Pediatrics: Surgery

      Pediatric Abdominal Trauma

      Updated: Apr 18, 2024
      • Author: Amulya K Saxena, MD, PhD, DSc, FRCS(Glasg); Chief Editor: Harsh Grewal, MD, FACS, FAAP  more...
      • Print
      Overview

      Practice Essentials

      Trauma is the leading cause of morbidity and mortality in the pediatric population. The abdomen is the third most commonly injured anatomic region in children, after the head and the extremities. Abdominal trauma can be associated with significant morbidity and may have a mortality as high as 8.5%. The abdomen is the most common site of initially unrecognized fatal injury in traumatized children.

      Management of abdominal injuries in children has evolved considerably and increasingly focuses on nonoperative measures. [1, 2]  It has been shown that nonoperative treatment of children with blunt abdominal trauma is successful in more than 95% of appropriately selected cases if trauma care providers have a thorough knowledge of the anatomy and physiology of the growing child. This article reviews the typical presenting signs, evaluation, and treatment of children with suspected abdominal injuries following trauma.

      For more information, see Abdominal Vascular Injuries, Penetrating Abdominal Trauma, Blunt Abdominal Trauma and Focused Assessment with Sonography in Trauma (FAST).

      Next:

      Anatomy

      Unique pediatric aspects of the anatomy and physiology of the abdomen contribute to the abdomen’s biomechanical response to traumatic loads.

      A young child’s abdomen is square and becomes more rectangular as the child matures. The abdominal wall of a child has thinner musculature than that of an adult, particularly during the first 2 years of life, providing less protection to underlying structures. The ribs are more flexible in the child and thus less likely to fracture; however, this increase in compliance makes the ribs less effective at energy dissipation and consequently less effective at protecting the upper abdominal structures (eg, the spleen and the liver). [3, 4, 5]

      The solid organs are comparatively larger in the child than in the adult; therefore, more surface area is exposed, making the organ more at risk for injury. A lower fat content and more elastic attachments are typical of the intra-abdominal organs in children. These characteristics reduce the amount of energy absorption and may result in increased motility and vulnerability (eg, kidneys). The child’s spleen has a thicker capsule than that of the adult, yet the spleen is among the most commonly injured solid organs in blunt abdominal trauma.

      In the young child, the intestine is not fully attached within the peritoneal cavity (especially the sigmoid and right colon), and this incomplete attachment potentially makes it more vulnerable to injury from sudden deceleration or abdominal compression. The bladder extends to the level of the umbilicus at birth and therefore is more exposed to a direct impact to the lower abdomen. With age, the bladder descends to its retropubic position.

      The rapid growth of the spine during adolescence influences its anatomy and biomechanical properties, particularly in the lumbar area. [6] In a child with a thin abdominal wall who is poorly restrained (lap belt only), the fulcrum of a flexion injury would be at the body of the spine, which exposes it to a flexion-distraction injury (Chance fracture). A child with a Chance fracture is more likely to have a concomitant intra-abdominal organ injury than is an adult with such a fracture. [7]

      Previous
      Next:

      Etiology

      More than 80% of traumatic abdominal injuries in children result from blunt mechanisms; most commonly, they are related to motor vehicle accidents (MVAs). Abdominal injuries may also result from falls or direct blows to the abdominal wall (eg, handlebar injury; see the image below).

      Abdominal wall findings from handlebar injury. Abdominal wall findings from handlebar injury.
      View Media Gallery

      In the United States, firearm injuries are by far the most common cause of penetrating wounds. Other causes of penetrating injuries include stab wounds, impalements, dog bites, and machinery-related accidents.

      Previous
      Next:

      Epidemiology

      Traumatic injuries continue to be the leading cause of death in children, far surpassing other causes in frequency. [8] Abdominal trauma accounts for 8-10% of all trauma admissions to pediatric hospitals. Penetrating injuries are less common in children and account for 8-12% of pediatric abdominal trauma admissions in most trauma centers.

      Despite declining national trends in firearm-related injury, gunshot wounds (GSWs) are the most common cause of penetrating injuries in the pediatric age group and represent the leading cause of death in Black males aged 15-24 years. [9]

      Previous
      Next:

      Prognosis

      Nonoperative treatment of children with blunt abdominal trauma is successful in more than 95% of appropriately selected cases if trauma care providers have a thorough knowledge of the anatomy and physiology of the growing child.

      The abdomen is injured in 25% of children with GSWs; of these wounds, 14% are fatal.

      Out of all forms of pediatric abdominal trauma, abdominal trauma secondary to assault or abuse is associated with the highest mortality. [10] Abdominal trauma related to child abuse also carries a particularly high risk of hollow-viscus injury.

      Previous
      Clinical Presentation
       
       
      Media Gallery
      of 8
      Find Us On
      About
      About Medscape Privacy Policy Editorial Policy Cookies Manage Preferences Terms of Use Advertising Policy Help Center
      Membership
      Become a Member About You Professional Information Newsletters & Alerts Market Research
      App
      Medscape
      WebMD Network
      Medscape Live Events WebMD MedicineNet eMedicineHealth RxList WebMD Corporate Medscape UK
      Editions
      English Deutsch Español Français Português UK
      All material on this website is protected by copyright, Copyright © 1994-2024 by WebMD LLC. This website also contains material copyrighted by 3rd parties.