Pediatric Trauma

4.7. Abdominal Trauma

Abdominal injuries are the third leading cause of traumatic death in children, after head and thoracic injuries.

Abdominal injuries can affect solid or hollow organs. The most common injury is that of the spleen. In general, the abdomen represents a site of "silent" hypovolemia. Other sites of silent hemorrhage that can be responsible for hypovolemia are the pelvis and the retroperitoneum.

Recognition of increasing abdominal distension, peritoneal signs, and progressive hypotension despite fluid resuscitation are signs of impending hemodynamic compromise, and indicate the need for surgical intervention. The FAST trauma scan examining 4 major quadrants with ultrasound guidance is a skill that can be acquired by emergency first responders. Blood in the right upper quadrant close to the liver is one of the most sensitive locations to look for blood. It is possible to estimate the degree of the hemoperitoneum: 1=minimal, 2=moderate, 3= large hemoperitoneum requiring surgical intervention.

Paramount to treatment is fluid and/or packed red blood cell replacement with constant reassessments of the patient's hemodynamic status. For most patients this treatment will be sufficient; surgical hemostasis is rarely needed. The unique features of the abdomen in children include a thin abdominal wall, a decreased AP diameter, increased lordosis, proportionately larger spleen and liver, exposition below the rib cage, and a kidney that is more anterior with less perinephric fat.