Exploratory laparotomy for abdominal injuries in children: a retrospective review of 36 cases
DOI:
https://doi.org/10.18203/2349-3291.ijcp20253786Keywords:
Abdomen, Children, Ileostomy, Injury, Intestine, Laparotomy, TraumaAbstract
Background: Abdominal injuries are a major cause of morbidity and mortality in children. The objectives of the current study were to review the demographics of children with abdominal injuries (blunt and penetrating) who required laparotomy. The study also aimed to identify the causes of injuries, organs involved, and outcomes of the surgical therapy provided.
Methods: This retrospective and descriptive study was conducted for a period of 10 years from January 1, 2013, to December 31, 2022, at the author’s department of Pediatric Surgery. The study included children aged ≤12 years who needed exploratory laparotomies for abdominal injuries caused by either blunt or penetrating trauma.
Results: During the study period, 36 children (30 boys and 6 girls) needed laparotomy for the management of abdominal injuries. Most children were aged 7 to 12 years (n=30; 83.33%). Indications for abdominal exploration included bowel perforation (n=20), penetrating abdominal injuries (n=9), and hemoperitoneum (n=7). Fifteen children were treated with repair or resection of bowel perforation(s). Nine required the creation of an ileostomy. Four children underwent splenectomy for shattered splenic injuries. Two deaths were documented.
Conclusions: Children aged 7 to 12 years were the most frequently injured, and this study also evidenced male preponderance. Bowel perforation(s) were documented in two-thirds of children. One-fourth of the cases needed the creation of a temporary terminal ileostomy for managing their bowel injuries.
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References
Bao Y, Ye J, Hu L, Guan L, Gao C, Tan L. Epidemiological analysis of a 10-year retrospective study of pediatric trauma in intensive care. Sci Rep. 2024;14:21058. DOI: https://doi.org/10.1038/s41598-024-72161-0
Amato S, Culbreath K, Dunne E, Sarathy A, Siroonian O, Sartorelli K, et al. Pediatric trauma mortality in India and the United States: A comparison and risk-adjusted analysis. J Pediatr Surg. 2023;58:99-105. DOI: https://doi.org/10.1016/j.jpedsurg.2022.09.036
Cintean R, Eickhoff A, Zieger J, Gebhard F, Schütze K. Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients. Eur J Trauma Emerg Surg. 2023;49:451-59. DOI: https://doi.org/10.1007/s00068-022-02088-6
Thakur (Rai) N, Jaiswal V, Singh A, Kumar N, Misra M, Tiwari S, et al. Epidemiology and pattern of injury of pediatric trauma patients in level l trauma centre of Northern India. Trauma. 2022;26:15-9. DOI: https://doi.org/10.1177/14604086221111202
Bašković M, Keretić D, Lacković M, Borić Krakar M, Pogorelić Z. The diagnosis and management of pediatric blunt abdominal trauma-A comprehensive review. Diagnostics (Basel). 2024;14:2257. DOI: https://doi.org/10.3390/diagnostics14202257
Lynch T, Kilgar J, Al Shibli A. Pediatric Abdominal Trauma. Curr Pediatr Rev. 2018;14:59-63 DOI: https://doi.org/10.2174/1573396313666170815100547
Chaudhari PP, Rodean J, Spurrier RG, Hall M, Marin JR, Ramgopal S, et al. Epidemiology and management of abdominal injuries in children. Acad Emerg Med. 2022;29:944-53. DOI: https://doi.org/10.1111/acem.14497
Mahmoud MA, Daboos MA, Bayoumi ASS, Helal AA, Almaawi A, Hassab MH, et al. Role of minimally invasive surgery in management of penetrating abdominal trauma in children. Eur J Pediatr Surg. 2021;31:353-61. DOI: https://doi.org/10.1055/s-0041-1726411
Paediatric Surgery Trainee Research Network. The Blunt Liver and Spleen Trauma (BLAST) audit: national survey and prospective audit of children with blunt liver and spleen trauma in major trauma centres. Eur J Trauma Emerg Surg. 2023;49:2249-56. DOI: https://doi.org/10.1007/s00068-022-01990-3
Mansiroglu AK, Cesur E, Firinci B, Caglar O, Yigiter M, Salman AB. Management of pancreatic and duodenal trauma in childhood: a university hospital experience over a 10-year period. Eur J Trauma Emerg Surg. 2024;50:1661-9. DOI: https://doi.org/10.1007/s00068-024-02506-x
Kordzadeh A, Melchionda V, Rhodes KM, Fletcher EO, Panayiotopolous YP. Blunt abdominal trauma and mesenteric avulsion: a systematic review. Eur J Trauma Emerg Surg. 2016;42:311-5. DOI: https://doi.org/10.1007/s00068-015-0514-z
Lai S, Wilhelm S, Morden R, Akay B, Novotny N, Stallion A, et al. Blunt trauma and diaphragm injury in children: An analysis of the national trauma data bank. Children (Basel) 2025;12:168 DOI: https://doi.org/10.3390/children12020168
Liang T, Roseman E, Gao M, Sinert R. The utility of the focused assessment with sonography in trauma examination in pediatric blunt abdominal trauma: A systematic review and meta-analysis. Pediatr Emerg Care. 2021;37:108-18. DOI: https://doi.org/10.1097/PEC.0000000000001755
Paltiel HJ, Barth RA, Bruno C, Chen AE, Deganello A, Harkanyi Z, et al. Contrast-enhanced ultrasound of blunt abdominal trauma in children. Pediatr Radiol. 2021;51:2253-69. DOI: https://doi.org/10.1007/s00247-020-04869-w
Pegoraro F, Giusti G, Giacalone M, Parri N. Contrast-enhanced ultrasound in pediatric blunt abdominal trauma: A systematic review. J Ultrasound. 2022;25:419-27. DOI: https://doi.org/10.1007/s40477-021-00623-6
Perin I, Guetter CR, Klüppel LE, Fachin CG, Pimentel SK. CT scan in the evaluation of pediatric abdominal trauma. Rev Col Bras Cir. 2022;49:3246. DOI: https://doi.org/10.1590/0100-6991e-20223246
Hassankhani A, Valizadeh P, Amoukhteh M, Jannatdoust P, Saeedi N, Sabeghi P, et al. Disparities in computed tomography utilization for pediatric blunt trauma: a systematic review and meta-analysis comparing pediatric and non-pediatric trauma centers. Emerg Radiol. 2023;30:743-64. DOI: https://doi.org/10.1007/s10140-023-02172-3
Gates RL, Price M, Cameron DB, Somme S, Ricca R, Oyetunji TA, et al. Non-operative management of solid organ injuries in children: An American Pediatric Surgical Association Outcomes and Evidence Based Practice Committee systematic review. J Pediatr Surg. 2019;54:1519-26. DOI: https://doi.org/10.1016/j.jpedsurg.2019.01.012
Williams RF, Grewal H, Jamshidi R, Naik-Mathuria B, Price M, Russell RT, et al. Updated APSA guidelines for the management of blunt liver and spleen injuries. J Pediatr Surg. 2023;58:1411-8. DOI: https://doi.org/10.1016/j.jpedsurg.2023.03.012
Butler EK, Mills BM, Arbabi S, Groner JI, Vavilala MS, Rivara FP. Laparoscopy compared with laparotomy for the management of pediatric blunt abdominal trauma. J Surg Res. 2020;251:303-10. DOI: https://doi.org/10.1016/j.jss.2020.01.030
Arslan S, Okur MH, Arslan MS, Aydogdu B, Zeytun H, Basuguy E, et al. Management of gastrointestinal perforation from blunt and penetrating abdominal trauma in children: analysis of 96 patients. Pediatr Surg Int. 2016;32:1067-73. DOI: https://doi.org/10.1007/s00383-016-3963-5
Kiragu AW, Dunlop SJ, Wachira BW, Saruni SI, Mwachiro M, Slusher T. Pediatric trauma care in low-and middle-income countries: A brief review of the current state and recommendations for management and a way forward. J Pediatr Intensive Care. 2017;6:52-9.
Stylianos S, Pearl RH. Abdominal trauma. In Pediatric Surgery. 7th Ed. 2012:289-309. DOI: https://doi.org/10.1016/B978-0-323-07255-7.00020-9
James IA, Gonzalez D, Ameh EA, Chirdan LB, Gaines B, Nwomeh BC. Abdominal Trauma. In: Ameh EA, Bickler SW, Lakhoo K, Nwomeh BC, Poenaru D (eds) Pediatric Surgery. Springer, Cham. 2020:315-22. DOI: https://doi.org/10.1007/978-3-030-41724-6_29
Soares-Aquino C, Atouguia D, Osório A, Mariz C, Campos M, Carmo L. Bladder injuries in pediatric Age: A 12-year experience in a tertiary center. Cureus. 2025;17:92693. DOI: https://doi.org/10.7759/cureus.92693
Le MTP, Herrmann J, Groth M, Reinshagen K, Boettcher M. Traumatic gallbladder perforation in children-Case report and review. Rofo. 2021;193:889-97. DOI: https://doi.org/10.1055/a-1339-1904