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The efficacy of computed tomography in evaluating abdominal injuries in children with major head trauma.

Physical examination may be unreliable in the evaluation of children with blunt abdominal trauma particularly in those with associated major head injuries. In the absence of obvious clinical signs or physical findings of intraabdominal injury, the usefulness of abdominal computed tomography in children is controversial. To test the efficacy of CT scans, a 12-month prospective study of computed tomography for the initial assessment of children with blunt abdominal trauma and major head injuries was carried out. Of 320 pediatric trauma admissions to our regional trauma center, 65 consecutive patients with Glasgow Coma Scores less than ten were managed with sequential head and abdominal computed tomography in the emergency room for (1) closed head injury and (2) suspected abdominal trauma. Fifteen patients (23%) were found to have significant intraabdominal injury. Only two required operative intervention. No patients died as a result of the abdominal injuries. In children with significant head trauma and suspected abdominal trauma, combined head and abdominal CT proved to be reliable.

Abdominal Injuries↗

[What is the potential for acute laparoscopy in penetrating abdominal injuries?].

AIM: The aim of this work was to show current opinions on performing acute laparoscopic exploration in penetrating injuries of the abdomen and to assess the authors' own experience in performing the above operation in conditions of the regional hospital. METHODOLOGY: The authors present 17 patients treated between the years 1997-2002 for penetrating injuries of the abdomen or suspected for a penetrating injury. Acute laparotomy was performed in 11 cases, acute laparoscopy in 6 patients. The authors specify certain indications which lead to the acute laparoscopy, the method performed and its diagnostic value. RESULTS AND CONCLUSION: In the group observed, an intraabdominal injury was diagnosed in 41% of the patients, in 59% of cases findings were negative. When the intraabdominal injuries were assessed, the group of the acute laparotomies had 54% of negative findings, the group of the acute laparoscopies had 66.6% of negative findings. Laparoscopy decreased the total number of all negative laparotomies from 59% down to 35%. Diagnostic laparotomy fits to complement a spectrum of examination methods. Especially in equivocal cases, when a penetrating injury is suspected, it decreases the number of so called "necessary" non-therapeutic laparotomies to a minimum. It is most efficient, compared to other diagnostic methods, in verifying injuries of the peritoneum and diaphragm. However, acute laparoscopy should be always performed by an experienced surgeon. A therapeutic potential of the acute laparoscopy depend on proficiency of the operating surgeon and on the technical potential of each hospital. However, they, mostly, still remain restricted to caring for minor, isolated intraabdominal injuries.

Abdominal Injuries↗

[Perforation of the small intestine caused by closed abdominal injury (review of 16 surgically treated cases)].

The cases of 16 patients undergoing surgical treatment for blunt rupture of the small bowel have been reviewed. Male sex was the most affected one, and the traffic accidents were the main cause of this lesion. A high incidence of multiple injuries was noted. Clinical features were often effective in establishing the diagnosis; when performed, peritoneal lavage was always usefull, whereas X-ray did not. Mortality rate was low, in spite of the regular attendance of associated injuries, depending upon early diagnosis and surgical treatment. Only one death is reported, due to the extend of shock, for the associated injuries.

Abdominal Injuries↗