ABDOMINAL INJURY

IN CHILDREN

Ms. Subin Mariya Jacob

2nd year MSc Nursing
NUINS
 ABDOMINAL TRAUMA
• Accounts for 8 % of pediatric trauma
• Abdomen is the third most commonly
injured anatomical region in children

TYPES OF TRAUMA

 Blunt injury [ >80%]

 Penetrating injury
ABDOMINAL ORGANS
PATTERNS OF ABDOMINAL ORGAN INJURY
BY MECHANISM OF INJURY
Frequency of Organ Injury Blunt Penetrating

Liver 15% 22%

Spleen 27% 9%

Pancreas 2% 6%

Kidney 27% 9%

Stomach 1% 10%

Duodenum 3% 4%

Small bowel 6% 18%

Colon 2% 16%

Other 17% 6%
 ETIOLOGY
Motor vehicle related crashes- as an

 Occupant ,

 Pedestrian or

 Bicycle rider

Other causes

 Sporting activities

 Falls &

 Child abuse
ANATOMICAL FEATURES CONTRIBUTING
TO ABDOMINAL INJURIES

Ribs are horizontally oriented,

More flexible- less likely for fractures

 offering less protection to the abdominal

organs e.g spleen , liver.

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Abdominal muscles are
less developed &
therefore thinner than in
the adult.

Organs are relatively

large and closer to the
source of impact.

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 PATHOPHYSIOLOGY
BLUNT INJURY ABDOMINAL ORGANS

• crushing & bursting of the solid

upper abdominal organs,

• perforation of the hollow viscus or

• shearing of the vascular supply after

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 PATHOPHYSIOLOGY
Penetrating injuries abdomen

The degree of damage is directly attributed to

the amount of kinetic energy

transferred to the surrounding tissue.

A high velocity weapon such as a gun produces more

damage to surrounding tissues than a knife woundPage 9
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DIAGNOSIS

History Collection

Physical Examination

Abdominal CT

Abdominal X Ray
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 PHYSICAL SIGN
Rapid, shallow breathing

Abdominal tenderness, Increasing abdominal

girth

Flank or abdominal mass, contusion or wound

Blood in the urethral meatus, hematuria

Inability to void
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Genital swelling or discoloration

Referred shoulder pain with upper abdominal

palpation

Internal bleeding
 hypotension : under 80 mm Hg in older
children; under 60 mm Hg in infants
 increasing pallor
 rapid respirations
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Injuries frequently associated
with abdominal injury
• Fractured lower ribs

• Penetrating trauma to the lower chest

• Pelvic fracture

• Multisystem trauma sustained during

motor vehicle crash
 MANAGEMENT
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• Non-operatively- most blunt injuries

• Operative
-unstable vitals even in the face of
aggressive fluid resuscitation, absence of
extra vascular volume loss or an enlarging
abdomen
-based on CT and physical findings:
peritoneal irritation, hypovolemia or free air
on plain film
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• Suspected abdominal injury-

• NG tube – aspirated content inspected for
visible blood & tested for occult blood
If blood – low suction
• Foleys- examine urine for blood
If blood – emergency IVP
• Paracentesis

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SPLENIC RUPTURE

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 CLINICAL FEATURES
• Tenderness in the left upper quadrant esp. on

deep inspiration

• Blood on abdominal paracentesis

• KEHR’S sign- radiated left shoulder pain

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 MANAGEMENT
IVF- replacement

IVP- Left kidney damage

CBC- extent of blood loss

Blood typing & cross matching- blood transfusion-

replacement

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• Mild blood loss from rupture
• - admitted for observation
• Severe blood loss
• - scheduled for immediate surgery: partial
or total splenectomy to halt bleeding &
save life
• FOLLOWING SPLENECTOMY
• Return of bowel functions
• Susceptible to infection e.g. pneumococcal
infections- immunisation
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 Free Powerpoint Templates

LIVER RUPTURE OR
LACERATION

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 CLINICAL FEATURES
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• Severe abdominal pain , most marked on

inspiration

• Symptoms of blood loss:

• Tachycardia, hypotension, anxiety & pallor,

low or falling hematocrit: SURGERY: liver
highly vascular organ & blood loss from it is
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acute & damaging
May have colicky upper abdominal pain

relieved by emesis

GI bleeding such as hematemesis or malena

– occur within few days

LIVER ARTERIOGRAM
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 MANAGEMENT
• Assess for peritonitis

• Following surgery observe return of

bowel functions

• Careful re-introduction of oral nutrition

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