Controversies in abdominal trauma.
The treatment of children who have major abdominal injuries has changed significantly during the past 2 decades. Surgical restraint has been the theme, and increased awareness of anatomic patterns and physiological responses has prompted successful nonoperative care of many solid organ injuries in children. The contributions of interventional radiologists and endoscopists in the treatment of injured children continue to increase. Injuries to the biliary tree and pancreatic ductal system are now treated with a multidisciplinary approach combining percutaneous, open, and endoscopic procedures. Trauma surgeons unfamiliar with a nonoperative approach often raise questions about the benefits of such treatment. Their concerns include the potential for increased transfusion requirements, increased length of hospital stay, and missed associated injuries; some even question the involvement of pediatric surgeons in nonoperative treatment protocols. The experience that has settled most such controversies is reviewed in this article.
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Division of Pediatric Surgery, Columbia University College of Physicians & Surgeons, New York, NY, USA.
D000007:Abdominal Injuries / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D004724:Endoscopy; D006801:Humans; D009104:Multiple Trauma / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D010348:Patient Care Team; D015642:Radiology, Interventional; D015996:Survival Rate; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D014950:Wounds, Penetrating / Q000401:mortality / Q000503:physiopathology / Q000628:therapy