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Diagnosis and Management of Blunt Abdominal Trauma in Children: Experience from a Newly Established Facility

Kumar Abdul Rashid, Assistant Professor, Department of Pediatric Surgery, Government Medical college, Srinagar, Jammu and Kashmir 190010, India. , Kumar Abdul Rashid1 , Zaffer Saleem Khanday2 , Amat Us Samie3 , Raashid Hamid4 , Sajad Ahmad5

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New Indian Journal of Surgery 9(4):p 474-478, July - August 2018. | DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9418.14

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Abstract

Background: Trauma is the leading cause of death in children in developed countries. In developing countries accidents are shown to be as numerous as in developed countries and it remains the major cause of blunt abdominal trauma in children. It is irony that thousands of children saved from nutritional and infectious diseases were killed or maimed by injuries. The management of these unfortunate children remains a challenge in developing countries where the advanced facilities and expertise are localized to only few centers, catering a vast population. The present study shares  our experience in managing children with blunt abdominal trauma. Causes of blunt abdominal trauma in children, their mode of presentation and subsequent challenges met in the management is discussed. 

Materials and Methods: All Patients with diagnosis of blunt abdominal trauma admitted to the Department of pediatric surgery, Government Medical College, Srinagar, Kashmir, India, from June 2011 to January 2018 were retrospectively analyzed. Individual case records were analyzed regarding mode of injury; presentation, associated injuries and treatment offered were studied. The data sheets were analyzed for the investigations ordered and the operative management if offered to the patients. The postoperative recovery and complications if any were recorded.

Results: A total of 251 children with a diagnosis of blunt abdominal trauma were admitted in the study period. There were 192 (76.4%) male patients and 59 (23.5%) were females. Road traffic accident was the commonest cause of  trauma (62%) followed by fall (29%), sports (3%) and animal violence related injuries (4%). Operative management was indicated in a total of 105 patients (41%). 80 patients with signs of pneumoperitoneum. 16 patients with solid organs injury needed operative intervention, while 9 patients with bladder and urethral injuries were operated. Rests of the patients were managed conservatively. Associated non­abdominal injuries were found in 67 (26.6%) patients. The mortality in the study was 7.5%. Those who expired had delayed presentation with low general condition at the time of presentation or had associated grievous injuries. 

Conclusion: Trauma is increasing rapidly as a cause of child mortality in developing countries, both in absolute numbers and in terms of populations. Children are more prone to blunt abdominal injuries due to various social factors. Anatomic differences and variations in body habitus seen in children may account for significant internal abdominal injuries in the absence of obvious external signs. Most of the pediatric abdominal injuries can be managed conservatively.  Those who need operative intervention are those having viscus perforations or multiple organ injuries. Mortality was related to delayed presentation and associated nonabdominal grievous injuries.

Keywords: Blunt Abdominal Trauma; Children; Management; Developing Country.

 

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DOI: DOI: https://dx.doi.org/10.21088/nijs.0976.4747.9418.14

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