The safety of pediatric blunt abdominal trauma in the hands of general surgeons

Objective: To determine the safety of management of pediatric blunt abdominal trauma in a general surgical ward by general surgeons with no experience in pediatric surgery. Design: Retrospective review of the case notes of all children under 13 years admitted with blunt abdominal trauma over 3-year period (January 1988 - December 1990). Setting: Department of Surgery, Dammam Central Hospital, Dammam, Saudi Arabia. Methods: The case notes of 56 children (46 boys, 10 girls) with blunt abdominal trauma were reviewed. Initial clinical examination, associated with surgery were recorded. Result: The cause of trauma were: road traffic accident in 27(48%), fall from height in 20 (36%), blow to abdomen in 5 and assault in 4. Additional injuries were present in 27 (48%) patients: head injury (thirteen), chest (seven), pelvis (three), upper limb (three) and lower limb (one). Plain abdominal radiographs were performed in all children. Ultrasound and CT scan were requested selectively and none of the children had peritoneal lavage. All were treated conservatively with good outcome except 5 (9%) who underwent exploratory laparotomy for worsening general and abdominal signs (n=2) and signs of peritonitis on admission (n=3). There was one postoperative morbidity and one mortality. Conclusion: Majority of blunt abdominal trauma in children can be managed conservatively with minimal morbidity and mortality in non-pediatric surgical units even in the hand of general surgeons. However, in presence of pediatric surgical service, management of such children should be undertaken by pediatric surgeons.