Journal of pediatric surgery
-
Comparative Study
Can ultrasonography replace computed tomography in the initial assessment of children with blunt abdominal trauma?
The evaluation of injured children with suspected blunt abdominal trauma (BAT) is clinically challenging. Computed tomography (CT) requires that patients be sedated, stable, and transportable, and even so, it is considered the diagnostic modality of choice for children with BAT. The authors questioned whether abdominal ultrasonography (US) performed during the initial assessment of the injured child is accurate enough to replace CT in the detection of intraabdominal injury. ⋯ The authors conclude that US is sensitive in detecting free peritoneal fluid or visceral injuries and is an effective screening modality. It has replaced abdominal CT in 76% of our patients with suspected BAT. In view of the reliability, simplicity, low cost, and bedside availability of US, the authors suggest that this modality be used in the initial assessment and diagnosis of children with suspected intraabdominal injury from blunt trauma.
-
The authors report on a 7-year-old boy who suffered an unintentional penetrating cardiac injury while misusing a lawn toy in a predictable way. The boy was hemodynamically stable, with abdominal pain and tenderness. ⋯ As in this case, children may not have the typical signs and symptoms of cardiac tamponade, making the diagnosis difficult and delaying appropriate care. This child's injury could have been prevented through increased parental supervision or a modified toy design that takes into account predictable patterns of misuse.
-
Twenty-one pediatric cases of abdominal cystic lymphangioma (CL) treated in the past 20 years are reviewed. To date, this is the largest reported series. CL is a rare congenital malformation that presents either with chronic abdominal distension (and is detected by palpation of a cystic mass) or acutely with bowel obstruction or signs of peritonitis. ⋯ With these techniques, a correct diagnosis should be achieved in nearly every case. Enucleation (when feasible) or segmental intestinal resection (when the cyst is intimate to the bowel) is effective treatment. In a few cases the malformation is diffuse, and extensive bowel resection is necessary, with the risk of short bowel syndrome.
-
Ninety-four children with penetrating chest injuries were treated at Dicle University School of Medicine during a 6-year period. The mean age was 11.51 +/- 3.31 years, and the male:female ratio was 5.25:1. Forty-five had stab wounds, 27 had high-velocity gunshot wounds, 13 had low-velocity gunshot wounds, seven had a bomb (shrapnel) injury, one had a shotgun wound, and one had a horse bite. ⋯ The morbidity rate was 8.51% (8 of 94). Only one death occurred after cervical tracheal repair. The study suggests that the majority of penetrating chest injuries in children can be treated successfully by tube thoracostomy alone or in conjunction with expectant observation.