Clinical recognition and management of pediatric blunt abdominal trauma without ultrasound or computed tomography scan in community hospitals in Mexico

Porras-Ramírez, G; Ramírez-Reyes, Francisco; Hernandez-Herrera, M. H.; Porras-Hernández, Juan Domingo

doi:10.1016/s0022-3468(99)90648-6

Cited by 2 publications

(2 citation statements)

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“…Four quadrants diagnostic peritoneal lavage (DPL) has been, in the past, a sensitive and specific method of investigating haemoperitoneum in children 13 . It is no longer a first‐line investigation, except where FAST or CT is not available 14 . DPL evaluation, together with good primary survey, still has a role in facilitating the decision to conduct emergency laparotomy.…”

Section: Assessmentmentioning

confidence: 99%

“…These guidelines (Table 3) were devised as a result of 87 surveys provided by senior paediatric surgeons in a trauma unit who had years of experience caring for children with splenic trauma. However, aspects of NOM, such as need for ICU admission, length of hospitalization, need for follow‐up imaging and length of activity restriction, remain variable 14 . Thompson and Holland in Australia advocated a controversial approach, 5 in that the decision for ICU admission was based on the patients’ injury severity score and whether laparotomy was performed.…”

Section: Managementmentioning

confidence: 99%

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Non‐operative management for blunt splenic trauma in children: An updated literature review

Leung¹,

Wong

Taylor

2007

Surgical Practice

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Introduction:The spleen is the most frequently injured abdominal organ in blunt trauma. In the past, any damaged spleen was surgically removed to avoid delayed rupture. Overwhelming infection is a real threat in asplenic children. Therefore, management of blunt splenic injuries has continued to change over the past 20 years towards non-operative management (NOM) and splenic conservation. Methods and Materials: Twenty-seven international articles on management of traumatic splenic rupture regarding advances in investigative techniques, treatment modalities and management protocols were reviewed. Results: With the advent of improved intensive care, interventional radiology and trauma protocols, it is reported that blunt splenic injuries can now be managed conservatively with a success rate of 85%. Computed tomography remains the gold standard of investigation in a stable patient. Focused abdominal sonography for trauma (FAST) offers a useful diagnostic tool in an unstable patient in whom the source of hypovolaemia is uncertain. However, negative FAST does not exclude haemoperitoneum. Furthermore, guidelines complemented by a comprehensive grading system have been devised to identify those patients who could avoid splenectomy. Experienced radiologists have advocated angio-embolization in stable patients, and their NOM has increased by 15%, although availability is limited. Post-discharge instructions are routinely given to parents and patients for successful recovery from NOM of splenic rupture. Conclusion: Surgeons must be familiar with these options in order to offer the safest and most effective care for children with splenic lacerations.

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Section: Assessmentmentioning

confidence: 99%

Section: Managementmentioning

confidence: 99%