Blunt intestinal injury in children: The role of the physical examination

Jerby, Brian L; Attorri, Robert J.; Morton, Duncan

doi:10.1016/s0022-3468(97)90711-9

Cited by 62 publications

(36 citation statements)

References 18 publications

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“…The issue is: ''When and for which signs the surgery should be indicated if the pneumoperitoneum is absent?'' [10,11,14]. We agree with Bruny and Bensard [12] that persistent peritoneal irritation associated with the changes in temperature, heart rate, leukocytosis, and low urinary output, despite anti-shock treatment, are very suspicious of occult gastrointestinal perforation, especially if the transverse abdominal wall ecchymoses are evident.…”

Section: Discussionsupporting

confidence: 71%

“…Whyte et al present a similar case, their patient was operated 4 h after injury and she was discharged after 20 days without any complication. Nevertheless the relationship between delayed surgery and high morbidity is still controversial [10][11][12][13]. The issue is: ''When and for which signs the surgery should be indicated if the pneumoperitoneum is absent?''…”

Section: Discussionmentioning

confidence: 99%

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Total prepyloric transection of stomach and vertebral trauma: case report and review of the literature

et al. 2008

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A rare injury of stomach associated with vertebral trauma in a 10-year-old girl, a victim of a traffic accident, is presented. Early X-ray and computerized tomography scan revealed no free abdominal air, only signs of pancreas contusion and fracture of the Th 12 and L 1 vertebral body were evident. Transection of stomach was revealed during endoscopy (an attempt to perform retrograde cholangio-pancreaticography) 20 h after the trauma. Primary suture of the rupture was performed. Sepsis and multiple organ dysfunction syndrome developed in the postoperative course. The girl subsequently underwent four laparotomies for abdominal infection, bleeding and colonic stricture. After resolution of the abdominal disorders the girl underwent surgical stabilization of spine. Currently, 2 years after trauma, she is doing well without any gastroenterologic dysfunction.

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Section: Discussionsupporting

confidence: 71%

Section: Discussionmentioning

confidence: 99%

Total prepyloric transection of stomach and vertebral trauma: case report and review of the literature

et al. 2008

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“…A large retrospective study suggested the rate of intra-abdominal injury to be 21% in the presence of the seat belt sign; however, that study was subject to selection bias as it only included hospitalized patients. 20 In addition, the rate of gastrointestinal injuries in those with seat belt signs (11% of those undergoing definitive abdominal testing) was lower compared to the nearly 25% identified in prior studies. 24,25 The rate of pancreatic injuries in those with seat belt signs was only 1% in the current study, which is lower than the 7% in the prior prospective study.…”

Section: Discussionmentioning

confidence: 79%

“…Pediatric studies of this topic primarily consist of case series or retrospective reviews. [8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24] A single-center prospective study demonstrated an association between the seat belt sign and intra-abdominal injury in children, but was limited by its small sample size. 25 In contrast, one pediatric study failed to demonstrate any association between the seat belt sign and intra-abdominal injury.…”

Section: Discussionmentioning

confidence: 99%

Association Between the Seat Belt Sign and Intra‐abdominal Injuries in Children With Blunt Torso Trauma in Motor Vehicle Collisions

Borgialli

Ellison

Ehrlich

et al. 2014

Academic Emergency Medicine

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Objectives: The objective was to determine the association between the abdominal seat belt sign and intra-abdominal injuries (IAIs) in children presenting to emergency departments with blunt torso trauma after motor vehicle collisions (MVCs).Methods: This was a planned subgroup analysis of prospective data from a multicenter cohort study of children with blunt torso trauma after MVCs. Patient history and physical examination findings were documented before abdominal computed tomography (CT) or laparotomy. Seat belt sign was defined as a continuous area of erythema, ecchymosis, or abrasion across the abdomen secondary to a seat belt restraint. The relative risk (RR) of IAI with 95% confidence intervals (CIs) was calculated for children with seat belt signs compared to those without. The risk of IAI in those patients with seat belt sign who were without abdominal pain or tenderness, and with Glasgow Coma Scale (GCS) scores of 14 or 15, was also calculated.Results: A total of 3,740 children with seat belt sign documentation after blunt torso trauma in MVCs were enrolled; 585 (16%) had seat belt signs. Among the 1,864 children undergoing definitive abdominal testing (CT, laparotomy/laparoscopy, or autopsy), IAIs were more common in patients with seat belt signs than those without (19% vs. 12%; RR = 1.6, 95% CI = 1.3 to 2.1). This difference was primarily due to a greater risk of gastrointestinal injuries (hollow viscous or associated mesentery) in those with seat belt signs (11% vs. 1%; RR = 9.4, 95% CI = 5.4 to 16.4). IAI was diagnosed in 11 of 194 patients (5.7%;

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“…Intestinal A incidência de lesão intestinal na criança em trauma abdominal fechado é de 1,4%, e, segundo Jerby 15 , o diagnóstico pode ser feito em 94% das crianças através do exame físico. Os principais sinais são de irritação peritoneal: abdome em tábua, paracentese positiva para conteúdo fecal ou alimento, e o tratamento geralmente é cirúrgico.…”

Section: Trauma Abdominalunclassified

Inicial care in severe pediatric trauma

Abramovici

Souza²

1999

J Pediatr (Rio J)

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ResumoObjetivos: Apresentar de forma objetiva e prática a abordagem terapêutica da criança vítima de trauma.Métodos: Foram revisados artigos da literatura, selecionandose aqueles que tratam das questões envolvendo a abordagem e o tratamento da criança com trauma.Resultados: A criança apresenta grande potencial de recuperação, porém a ressuscitação inadequada é considerada a maior causa de óbitos por trauma passível de prevenção. Cuidados na abertura e manutenção da via aérea, na oferta adequada de fluido para a criança vítima de politraumatismo e queimaduras, assim como no diagnóstico precoce e tratamento efetivo de hemorragias internas melhoram o prognóstico e reduzem drasticamente as taxas de mortalidade.O atendimento inicial da criança vítima de politraumatismo exige imediato tratamento da falência respiratória, do choque e das lesões de tórax com risco de vida para assegurar efetividade de ventilação, oxigenação e perfusão até o tratamento definitivo. Simultaneamente, a coluna cervical deve ser protegida de possível lesão já existente ou aparecimento de futura lesão.Conclusões: Medidas efetivas de prevenção de acidentes, leis rigorosas de proteção à criança e ao adolescente, associadas ao treinamento no atendimento ao politraumatismo reduziriam significativamente os preocupantes índices de morbi-mortalidade em nosso país.J. pediatr. (Rio J.). 1999; 75 (Supl.2): S268-S278: politrauma, criança politraumatizada, trauma, queimaduras. AbstractObjectives: To present objectively the therapeutic aspects for the management of child victim of trauma.Methods: The most relevant articles about the management of acute trauma were selected.Results: Children possess great potential for recovery after a trauma, however, inappropriate resuscitation is the major cause of death preventable.Care in the opening and maintenance of the airways, adequate input of fluid to the child victim of politrauma or burns as well as prompt diagnosis and effective management to internal bleeding has improved prognosis and can reduce mortality considerably. Initial assessment and management of the injured child requires immediate procedures towards respiratory failure, shock and life-threatening thoracic injuries in order to provide efficient ventilation, oxygenation and perfusion until definitive treatment is performed. Concomitantly, the cervical spine should be protected against new injuries or progression of established injury.Conclusions: Effective actions in order to prevent accidents and rigorous laws to protect children and adolescents, associated to training and practice of specific procedures to the politraumatized child could surely reduce the unacceptable morbi-mortality in our country.J. pediatr. (Rio J.). 1999; 75 (Supl.2): S268-S278: pediatric injury, pediatric trauma, injured child, polytrauma, burns. Presidente do Departamento de Emergências da IntroduçãoTrauma é a doença do século XX e pode ser classificada corretamente como uma epidemia que, se não forem tomadas medidas eficazes para um programa nacional de prevenção, deverá ...

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Blunt intestinal injury in children: The role of the physical examination

Cited by 62 publications

References 18 publications

Total prepyloric transection of stomach and vertebral trauma: case report and review of the literature

Total prepyloric transection of stomach and vertebral trauma: case report and review of the literature

Association Between the Seat Belt Sign and Intra‐abdominal Injuries in Children With Blunt Torso Trauma in Motor Vehicle Collisions

Inicial care in severe pediatric trauma

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