title: The use of laparoscopy in the management of seat belt trauma in children.
abstract: Abdominal wall, hollow viscous, and spinal cord injuries are severe complications of two point seat belt restraints in children. Somatic abdominal wall pain can mask the presence of potentially life-threatening intraperitoneal injuries, false-positive peritoneal lavage can lead to unnecessary celiotomy, and CT scan can miss hollow viscous injury. All of these concerns point to the need for a more effective diagnostic modality. Laparoscopy may have a role in the diagnosis and management of lap belt-related hollow viscous and mesenteric injuries. The presence of either free peritoneal fluid or mesenteric thickening, seen on CT scan, associated with an seat belt-related abdominal wall contusion are criteria for diagnostic laparoscopy. Four patients, age 3 to 15, underwent laparoscopy. Diagnostic laparoscopy employed two additional laterally placed ports and extreme Trendelenburg and reverse Trendelenburg to facilitate the thorough examination of the small bowel. Injuries identified were a severely contused cecum, a contusion of the small bowel with associated mesenteric hematoma, transverse colon contusion and gastric perforation, and a small bowel contusion. No delayed reexplorations were required for missed injuries and there were no complications associated with laparoscopy. This experience suggests that laparoscopy may have a role in the diagnosis and management of seat belt trauma in children.
authors.affiliation: Department of Surgery, Michigan State University Butterworth Hospital, Grand Rapids, USA.
authors.forename: W E
authors.initials: WE
authors.lastname: VanderKolk
authors.forename: V F
authors.initials: VF
authors.lastname: Garcia
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000209:etiology; D000293:Adolescent; D000465:Algorithms; D002648:Child; D002675:Child, Preschool; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D011187:Posture; D012622:Seat Belts / Q000009:adverse effects*; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000175:diagnosis* / Q000209:etiology