Imaging of abdominal trauma

Imaging in pediatric blunt abdominal trauma. (2008)

“Pediatric patients frequently suffer blunt trauma as a result of a motor vehicle or bicycle accident. Contrast-enhanced CT is the preferred imaging modality in the evaluation of intraabdominal injury. Oral contrast is not commonly used in the setting of trauma but may be indicated in rare instances such as suspected pancreatic injury. The presence of a lap-belt ecchymosis or the specific history of a handlebar injury should raise suspicion for an intraabdominal injury. Nonoperative management is typical for uncomplicated spleen and liver injuries and is gaining popularity for uncomplicated pancreatic and renal injuries. Absolute indications for surgery include perforating bowel injury and multiple organ injury resulting in extreme clinical instability. The injuries detected at CT determine the appropriate degree of patient monitoring in the hospital (ie, intensive care unit versus regular ward), length of hospitalization, and amount of activity restriction after discharge.”

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Complications of nonoperative management of pediatric blunt hepatic injury: Diagnosis, management, and outcomes. (2006)

“Complications of NOM of pediatric blunt hepatic injury are rare, but may include biloma, hepatic artery pseudoaneurysm, and necrotic gallbladder. Complications occur only with Grade III or greater injuries and are accompanied by fever, right upper quadrant pain, feeding intolerance, and persistently elevated LFTs. The clinician must maintain a high index of suspicion for the development of complications and have a low threshold for obtaining a CT or US for diagnosis. Interventional radiology techniques, angiography, and ERCP are useful adjuncts to nonoperative management, but some patients may still require laparotomy for management of complications.”

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Abdominal trauma in infants and children: prompt identification and early management of serious and life-threatening injuries. Part I: injury patterns and initial assessment. (2000)

“Evaluation of children with abdominal trauma can be a difficult process. Unique anatomic features predispose children to specific injuries and potentially make identification of life-threatening injuries difficult. While Part I of this review discusses the initial assessment and diagnostic testing in children with abdominal trauma, Part II will review specific injuries and ED management of children with possible abdominal trauma. Knowledge of each of these factors will improve the ability of general and pediatric emergency physicians to expeditiously identify children with potential serious injury and initiate appropriate treatment.”

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The value of routine follow-up imaging in pediatric blunt liver trauma. (2000)

“Our series suggests that in asymptomatic patients, US and CT follow-up studies do not provide the additional information needed for patient management. Therefore, we believe that in asymptomatic children with blunt hepatic trauma who are clinically stable, routine follow-up imaging studies are of very limited value.”

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More PubMed results on imaging of pediatric blunt trauma.

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