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tree. Children with hematobilia present several days to weeks after a blunt
abdominal trauma with abdominal pain and upper gastrointestinal tract bleeding.
Hepatic angiography confirms the diagnosis. Embolization is used to achieve
hemostasis and is almost always successful, but partial hepatic resection may be
necessary when this treatment fails.

PENETRATING ABDOMINAL TRAUMA
Goals of Treatment
The approach to these patients includes identification and management of all lifethreatening injuries and treatment of hemorrhagic shock. The need for laparotomy
must be determined quickly, and a broad-spectrum antibiotic that covers both
gram-positive and gram-negative bacteria should be given. Intra-abdominal
organs are at risk for penetrating trauma, depending on their size and location.
Hypovolemia or signs of peritonitis, or both, are the results of brisk
hemorrhage and spillage of enteric contents into the peritoneal space.
CLINICAL PEARLS AND PITFALLS
Penetrating abdominal trauma is much less common than blunt trauma
in children younger than 16 years of age and accounts for less than
10% of pediatric trauma injuries.
The high morbidity and mortality associated with penetrating trauma to
the abdomen is a result of the destructive force of ballistic missiles and
fragments, rapid hemorrhage of vascular structures and solid organs
after missile and stab injuries, difficulty in surgical repair of grossly
injured intra-abdominal organs, and postoperative complications.
The colon and small bowel are large in volume and are the most
commonly injured structures, followed by the liver, spleen, and major
vessels.

Gunshot Wounds
The destructive energy of ballistic missiles and fragments is related to mass and
velocity (kinetic energy = ½MV 2, where M is the mass and V is the velocity), and
more than 90% of gunshot wounds to the abdomen are associated with significant

injuries. Hollow viscera and large vessels are often involved, and solid organs
such as the liver and the spleen may demonstrate burst injuries. Therefore,
laparotomy is mandated in virtually all gunshot wounds to the abdomen.