Trauma is the leading reason of morbidity and mortality in the pediatric population. The abdomen is the third most generally injured anatomic an ar in children, after the head and also the extremities. Ab trauma have the right to be connected with far-reaching morbidity and also may have actually a mortality as high together 8.5%. The abdomen is the most usual site of originally unrecognized fatal injury in traumatized children.
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Management of abdominal injuries in kids has evolved considerably. <1> It has actually been displayed that nonoperative treatment of kids with blunt ab trauma is successful in more than 95% of appropriately selected cases if trauma treatment providers have a thorough understanding of the anatomy and also physiology of the cultivation child. This post reviews the typical presenting signs, evaluation, and treatment of children with suspected abdominal injuries following trauma.
For much more information, seeAbdominal Vascular Injuries,Penetrating ab Trauma,Blunt ab TraumaandFocused Assessment v Sonography in Trauma (FAST).
For patient education resources, watch theWounds Center, theTrauma source Center, and theChildren’s health Center, as well asPuncture WoundandBruises.
Unique pediatric facets of the anatomy and also physiology the the abdomen contribute to the abdomen’s biomechanical an answer to traumatic loads.
A young children abdomen is square and becomes more rectangular as the kid matures. The abdominal wall of a child has thinner musculature 보다 that of one adult, particularly during the very first 2 year of life, offering less protection to basic structures. The ribs are much more flexible in the child, which renders them less likely come fracture. However, this increase in compliance makes them less reliable at power dissipation and, therefore, less efficient at protecting the upper abdominal structures (eg, the spleen and the liver). <2, 3, 4>
The solid organs space comparatively larger in the son than in the adult; therefore, an ext surface area is exposed, do the organ much more at danger for injury. A reduced fat content and much more elastic attachments are common of the intra-abdominal guts in children. These features reduce the quantity of power absorption and also may result in increased motility and also vulnerability (eg, kidneys). The child’s spleen has actually a more thick capsule 보다 that the the adult, yet the spleen is among the most frequently injured heavy organs in blunt ab trauma.
In the young child, the intestine is not fully attached within the peritoneal cavity (especially the sigmoid and right colon), and this incomplete attachment perhaps makes it an ext vulnerable come injury from sudden deceleration or ab compression. The bladder extends come the level that the umbilicus in ~ birth and therefore is more exposed come a direct influence to the lower abdomen. With age, the bladder descends to its retropubic position.
The rapid expansion of the spine throughout adolescence influences its anatomy and also biomechanical properties, an especially in the lumbar area. <5> In a boy with a thin abdominal wall surface and who is poorly limit (lap belt only), the fulcrum the a flexion injury would certainly be at the human body of the spine, i m sorry exposes it to a flexion-distraction injury (Chance fracture).
More 보다 80% that traumatic ab injuries in children an outcome from dull mechanisms; most commonly, castle are concerned motor vehicle accidents. Abdominal muscle injuries might also result from falls or straight blows to the abdominal wall (eg, handlebar injury; check out the picture below).
In the united States, firearm injuries room by much the many common reason of penetrating wounds. Other causes of penetrating injuries include stab wounds, impalements, dog bites, and also machinery-related accidents.
Traumatic injuries continue to be the leading cause of fatality in children, much surpassing other causes in frequency. <6> ab trauma accounts because that 8-10% of all trauma admissions to pediatric hospitals. Penetrating injuries space less typical in children and account for 8-12% the pediatric abdominal muscle trauma admissions in many trauma centers.
Despite decreasing national patterns in firearm-related injury, gunshot wounds (GSWs) room the many common cause of penetrating injuries in the pediatric period group and also represent the leading cause of death in black color males aged 15-24 years. <7>
Nonoperative therapy of youngsters with blunt ab trauma is effective in an ext than 95% of as necessary selected cases if trauma treatment providers have actually a thorough understanding of the anatomy and also physiology of the cultivation child.
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Out of all forms of pediatric ab trauma, abdominal trauma secondary to assault or abuse is associated with the highest possible mortality. <8> ab trauma related to child abuse additionally carries a particularly high hazard of hollow-viscus injury.