title: [Haemorrhagic shock after severe abdominal trauma in children: knowing when to change from conservative to surgical management].
abstract: Abdominal vascular injuries following a serious falling out are quite rare in children. They can lead to haemorrhagic shock whose etiological diagnosis may be difficult in children in case of multiple trauma. The current management of abdominal injuries in the child is usually conservative, surgery being indicated in haemodynamically unstable patients. We report the case of a 7-year-old girl who presented with abdominal trauma with rupture of the hepatic artery and shredding of the splenic vein following a falling out of 10 meters. Aggressive resuscitation associated with early laparotomy for haemostasis, contrary to usual practices advocated in such a context, have helped control the hemorrhagic shock and stabilize the haemodynamic status of the child. The subsequent evolution was favourable, with full recovery. While a conservative attitude usually prevails in the management of traumatic intra abdominal bleeding in children an interventional attitude with emergency surgery must be sometimes considered.
authors.affiliation: Département d'anesthésie-réanimation, hôpital Necker-Enfants-Malades, 149, rue de Sèvres, 75015 Paris, France.
authors.forename: R
authors.initials: R
authors.lastname: Jouffroy
authors.forename: N
authors.initials: N
authors.lastname: Bourdaud
authors.forename: H
authors.initials: H
authors.lastname: Cuttaree
authors.forename: F
authors.initials: F
authors.lastname: Sauvat
authors.forename: P
authors.initials: P
authors.lastname: Carli
authors.forename: G
authors.initials: G
authors.lastname: Orliaguet
mesh_terms: D000007:Abdominal Injuries / Q000150:complications* / Q000601:surgery*; D002648:Child; D005260:Female; D006499:Hepatic Artery / Q000293:injuries*; D006801:Humans; D015601:Injury Severity Score; D012771:Shock, Hemorrhagic / Q000209:etiology* / Q000601:surgery*; D013162:Splenic Vein / Q000293:injuries*