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TABLE 103.2
INDICATIONS FOR IMMEDIATE LAPAROSCOPY OR LAPAROTOMY
FOR CHILDREN WITH ABDOMINAL TRAUMA
Multisystem injuries with indications for craniotomy in the presence of free
peritoneal fluid on ultrasonography, or strong historical, physical, or
radiographic evidence of abdominal injury
Persistent and significant hemodynamic instability with evidence of abdominal
injury in the absence of extra-abdominal injury
Penetrating wounds to the abdomen
Pneumoperitoneum
Significant abdominal distention associated with hypotension
CLINICAL PEARLS AND PITFALLS
The administration of IV contrast is essential for abdominal CT for the
evaluation of an injured child.
Abdominal CT has low sensitivity for small gastrointestinal perforations
and pancreatic injury.
Judicious use of the combination of physical examination, laboratory
screening values, and CT scanning is indicated for the stable patient.
Imaging protocols that use the lowest possible dose of radiation
exposure for the child should be utilized.
A FAST examination is not sufficient to exclude intra-abdominal injury.

EMERGENT VERSUS SELECTIVE LAPAROSCOPY OR
LAPAROTOMY
Goals of Treatment
The indications for immediate laparoscopy or laparotomy are limited in blunt
abdominal trauma in children ( Table 103.2 ). In most cases of abdominal trauma
in children ( Fig. 103.2 ), emergency laparotomy is not necessary and further
diagnostic studies direct either elective (selective) laparoscopy or observation and
monitoring. In the case where there is concern for an intra-abdominal injury in a
stable child, laparoscopy is a useful diagnostic and potentially therapeutic tool,

and allows the trauma team to rapidly and safely “know” if there is an injury