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Indian Journal of Trauma and Emergency Pediatrics

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Conservative Management of Blunt Abdominal Trauma with Solid Organ Injury in the Paediatric Age Group: Our Experience

Hemanshi Shah** , Charu Tiwari* , Hemanshi Shah** , Shalika Jayaswal*** , Mukta Waghmare* , Kiran Khedkar* , Pankaj Dwivedi*

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Indian Journal of Trauma and Emergency Pediatrics 8(3):p 215-219, Sept - Dec 2016. | DOI: DOI: http://dx.doi.org/10.21088/ijtep.2348.9987.8316.6

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Abstract

 Background: In paediatric age­group, blunt abdominal trauma is more common and associated with multisystem involvement. Missed or delayed diagnosis can be fatal. Conservative management has been the gold standard for management of solid organ injury in clinically stable paediatric patients. Materials and Methods: Twenty­four patients less than 12 year age who were admitted between August 2012 and July 2016 with solid organ injury following Blunt Abdominal Trauma were analyzed on the basis of age, sex, mode of trauma, presenting symptoms and signs, investigation findings, organ involved, grade of injury, management and outcome. Results: The average age at presentation was 6.6 years. There were 17 males (70.8%) and 7 females (29.16%). Road traffic accident was the most common mode of injury. Eight patients (40%) had liver trauma of which seven had trauma of grade III­IV. Seven patients (35%) had splenic trauma of which six had trauma of grade II­IV. One patient had splenic artery pseudoaneurysm with multiple collaterals associated with traumatic pancreatitis. She was managed by DSA and splenic artery coiling. Eight patients (40%) had renal trauma – three had grade II trauma, one had grade I and one had grade V trauma. Three patients had urinary extravasation requiring USG guided nephrostomy drain to relieve abdominal distention. All had underlying occult urinary obstruction and underwent interval AndersonHynes dismembered pyeloplasty for the obstruction. Three patients had injuries involving 2 organs. Three patients had pancreatic injury. All patients had ileus secondary to haemoperitoneum for 48 to 72 hours. The haemoperitoneum resolved completely in all patients on USG by 3 to 5 days. All patients were conservatively managed. Six patients required image guided intervention. Two patients required ERCP and three patients underwent ultrasound­guided pigtail insertion to relieve the urinoma. One patient required DSA with coiling of splenic artery pseudoaneurysm. All patients responded successfully to conservative management. There was no mortality in this study. Conclusion: Conservative management of solid organ injuries is an accepted mode of management of BAT in children with good outcome and fewer complications.

Keywords: Solid Organ Trauma; Blunt Abdominal Trauma; Paediatric Age Group

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DOI: DOI: http://dx.doi.org/10.21088/ijtep.2348.9987.8316.6

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