Nonoperative Management of Children with Blunt Abdominal Trauma

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=

Abstract

=

Nonoperative Management of Children with Blunt Abdominal Trauma

Kyung Jae Kim, M.D.,

000

Sun Lee, M.D.

Division of Pediatyric SurgeTY, Department

0/

Surgery, College of Medicine, Dankook University Chortan, Korea

The management of twenty-two cllildren with blunt abdominal trauma was analyzed. Nineteen cases had intraabciominal injuries; involving the spleen in 7 cases, the liver in 5, the pancreas in one and the bladder in one. There were five case multiple intraabdominal organ injuries. Seventeen out of 19 patients were treated non-operatively, but one was operated upon later because of de- layed bleeding. Thirteen patients required transfusion in the non operated group, the mean values of the Pediatric Trauma Score (PTS) was 11.3. The mean low- est hemoglobulin(LHb) was 9.1 g/ dL. The mean value of three cases with extraabdominal injuries were 9.0 and 8.3 g/ dL respectively. The average amount of tranfusion was ' 17.3 ml/kg. In the operated group, 2 cases were transfused an average of 139.8 ml/kg and their mean PTS was 5 and LHb was 6.6 g/ dL. In one out of 16 non-operated cases, intrahepatic hematoma developed and but resolved conservatively. However, two out of 3 operated cases suffer complica- tions such as an intubation granuloma and an intraabdominal abscess with wound dehescence. In conclusion, non-operative managenent in child with blunt abdominal trauma was safe in Grade I and II solid organ injuries. The decision for operation should be based on the hemodynamic stability after initial resuscitation including transfusion.

Index Words:Blunt trauma a bdomen, P ediatric

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Table 1.

Organs and Grades of Injury in Nonoperated

and

Operated

Groups

Injury organ

No. of

Case Grade** No. of

Case

Nonoperated(N = 16)

Spleen⁶ 7

2

5

1

3

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idney

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CT grade

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Pediatric Trauma Scores, Hemoglobulin Concentration and Transfusion Amount. of Nonoperated and Operated Groups in Transfused Patients

Nonoperated (n = 3)

Operated(n

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PTS 9.0

(7-11)

5.0 (5,5)

LHb(g/dL) 8.3 (7.2-10.6)

6.6 (4

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Abbreviations: PTS; Pediatric Trauma Score. LHb; Lowest Hemoglobulin

Transf usion (ml/kg) 17.3 01.7-26.3)

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