During the past decade, the management of children with blunt abdominal trauma was remarkably improved by virtue of development of medical technology and imaging techniques. Despite such development, problems and controversies concerning accurate
diagnosis, delineation of the injury and the decision for correct management of the different organ injuries still exist. We compared the different therapeutic approachs and the result of the management between two groups with abdominal trauma.
Eighty
nine children of the first group(G1) had been admitted during 5-year period between January 1981 and December 1985 before we had an abdominal computed tomographic(CT) scanner. The second group(G2) consisted of a hundred and thirty four children
admitted
between June 1987 and May 1992 after introduction of the CT scanner to our hospital in 1986. The cause of injury, Injury severity, number of associated injuries and the distribution of injured organs were not significantly different between two
groups.
The most common diagnostic procedure was paracentesis or peritoneal lavage(79%) in G1 and abdominal CT scan(68%) in G2. Between two periods we had changed the strategy of the management of blunt abdominal trauma from early laparotomy into
nonoperative
treatment, as far as vital sign is stable and there is no evidence of hollow viscus injury. Seventy two children(82%) of G1 and only thirty four(25%) of G2 underwent laparotomy Considered patients with solid organ injuries, the operation rate in
G2
was
even less(20%) compared with it(82%) in G1.
The operation rate of each solid organ injury also decreased, 69% to 12% in renal injury, 100% to 54% in spleen, 100% to 29% in liver and 100% to 44% in pancreas. The mortality was not much different between two groups, but the complication rate
was
higher in G1(25%) than in G2(9%), and higher in operated patients of G2(23%) than in nonoperated ones of G2(6%). We conclude that nonoperative management can be however, pitfalls of nonoperative management for children with blunt abdominal trauma
still
exist because of limitation of diagnosis for hollow viscus injury.
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