[Management of blunt abdominal trauma in children].
The aim of this study was to evaluate the radiological and therapeutic management of blunt abdominal trauma (BAT) in children, with retrospective data.


METHODS
During 6 years (Nov 1995-Oct 2001), 92 children were hospitalised for BAT (mean age 9.5 years; 61.9% boys). Falls (45.6%) and motor vehicle accidents (43.5%) were the most frequent causes. The initial management included abdominal plain film X-ray and ultrasonography, and sometimes computed tomography (CT). The non-operative treatment was used, unless the patient was hemodynamically unstable or had hollow visceral injury, diaphragmatic rupture or renal artery rupture.


RESULTS
Among 92 BAT, 52 were minor traumas and 40 were associated with one or several abdominal injuries. The sensitivity of ultrasonography to find hemoperitoneum and/or abdominal injuries was 80.3%, but the initial diagnosis of such lesions was accurate in 21 cases (52.5%) and delayed in 19 cases (47.5%), ranging from 1 to 7 days. In the delayed cases, the diagnosis was possible in nine cases with ultrasonography, in five cases with CT, but also with transaminase, amylase or lipase assays in two cases, and surgery in three cases. Twenty-nine children had a non-operative treatment and stayed in hospital about 12 days on average. Three children had surgery in emergency (two bowel perforations and one splenic rupture) and eight with delay (four renal ruptures, one associated splenic nodes, one pancreatic pseudocyst and one duodenal perforation). Only seven children (17.5%) required blood transfusion and no death occurred.


CONCLUSIONS
In a trauma centre, the management of abdominal injuries is possible with ultrasonography and its sensitivity is correct without increasing of morbidity and mortality. But, if in doubt, a CT must be performed because its sensitivity is better. Most of the time, the children can benefit from non-operative treatment.
Cotte
A
A
Service de chirurgie pédiatrique, CHU Hôpital-Nord, 42055Saint-Etienne 2, France.
Guye
E
E
Diraduryan
N
N
Tardieu
D
D
Varlet
F
F
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000628:therapy*; D000063:Accidents, Traffic; D000293:Adolescent; D001803:Blood Transfusion; D002648:Child; D002675:Child, Preschool; D003937:Diagnosis, Differential; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014193:Trauma Centers / Q000706:statistics & numerical data; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000628:therapy*