Pediatric emergency medicine trisk 3195 3195

FIGURE 103.8 Abdominal computed tomography of a 6-year-old boy who fell onto the handlebar of his bicycle, showing a pancreatic hematoma and pseudocyst formation Nasogastric decompression and bowel rest are indicated when pancreatic injury is suspected Nonoperative therapy is normally used initially for children with isolated pancreatic contusion caused by blunt trauma Maturation of the pseudocyst may necessitate surgical drainage, although spontaneous resolution may occur in 25% of children Experience with percutaneous drainage of pancreatic pseudocysts in children is increasing, but the traditional approach has been to use surgical internal drainage once a pseudocyst has persisted beyond weeks When severe pancreatic crush or transection is suspected, the surgeon may elect to perform immediate exploration and resection or drainage Hollow Abdominal Viscera Injuries Intestinal perforation caused by blunt abdominal trauma is rare in the pediatric age group, but the most common causes of this injury are automobile–pedestrian trauma, automobile lap belt injuries, and child abuse The mechanisms of injury usually involve rapid acceleration or deceleration of a structure near a point of anatomic fixation (e.g., ligament of Treitz), or trapping of a piece of bowel between two unyielding structures such as a lap belt and the spine Hollow visceral injury may be difficult to diagnose because physical findings may be minimal and/or nonspecific for the first few hours, and abdominal CT is not particularly sensitive in this situation However, bowel contents, bile, and activated pancreatic enzymes are extremely irritating to the peritoneum over time