Pediatric emergency medicine trisk 3189 3189

BLUNT ABDOMINAL TRAUMA
Goals of Treatment
The goals of the evaluation and treatment of children with blunt abdominal
trauma are to differentiate serious from nonthreatening injuries and determine the
next steps for treatment. Suspicion for serious intra-abdominal injuries is based
on the mechanism of injury and careful abdominal examination. Bilious or bloody
vomiting, persistent vomiting, abdominal distention, any signs of peritoneal
irritation, and rectal blood or hematuria suggest possible visceral injury, as does
an elevation in amylase or liver transaminase levels in cases in which a clinical
decision is made to obtain these studies. A low threshold for the use of abdominal
CT should be maintained.
CLINICAL PEARLS AND PITFALLS
Children with a troubling history or any worrisome signs should receive
a diagnostic laboratory evaluation and should be observed in
consultation with a surgeon.
Children with even minor contusions of the liver, spleen, pancreas, or
hollow viscera should be hospitalized.

Abdominal Wall Contusions
Many children have minor trauma to their abdomen in the course of play and as a
result of minor accidental events. Balls, bats, swings, toys, and contact with other
children may cause contusions of the abdominal wall. Children subjected to
minor forces without signs of intra-abdominal pathology (e.g., distention,
tenderness on deep palpation, peritoneal irritation) can be sent home.

Solid Organ Injuries
The spleen is the most commonly injured intra-abdominal organ, followed by the
liver. Most of these injuries are the result of automobile–pedestrian trauma,
although falls and bicycle accidents are also common mechanisms. The potential
morbidity and mortality result from the highly vascular anatomy of this organ and
hemorrhage into the large potential space of the peritoneal cavity.

Patients who have splenic injuries may present with either diffuse abdominal
pain or localized tenderness. Subphrenic blood may cause referred left shoulder
pain (Kehr sign). Percussion and palpation tenderness is usually of greatest
magnitude in the left upper quadrant of the abdomen. Abdominal radiographs