Pediatric emergency medicine trisk 3197 3197

tree Children with hematobilia present several days to weeks after a blunt abdominal trauma with abdominal pain and upper gastrointestinal tract bleeding Hepatic angiography confirms the diagnosis Embolization is used to achieve hemostasis and is almost always successful, but partial hepatic resection may be necessary when this treatment fails PENETRATING ABDOMINAL TRAUMA Goals of Treatment The approach to these patients includes identification and management of all lifethreatening injuries and treatment of hemorrhagic shock The need for laparotomy must be determined quickly, and a broad-spectrum antibiotic that covers both gram-positive and gram-negative bacteria should be given Intra-abdominal organs are at risk for penetrating trauma, depending on their size and location Hypovolemia or signs of peritonitis, or both, are the results of brisk hemorrhage and spillage of enteric contents into the peritoneal space CLINICAL PEARLS AND PITFALLS Penetrating abdominal trauma is much less common than blunt trauma in children younger than 16 years of age and accounts for less than 10% of pediatric trauma injuries The high morbidity and mortality associated with penetrating trauma to the abdomen is a result of the destructive force of ballistic missiles and fragments, rapid hemorrhage of vascular structures and solid organs after missile and stab injuries, difficulty in surgical repair of grossly injured intra-abdominal organs, and postoperative complications The colon and small bowel are large in volume and are the most commonly injured structures, followed by the liver, spleen, and major vessels Gunshot Wounds The destructive energy of ballistic missiles and fragments is related to mass and velocity (kinetic energy = ½MV 2, where M is the mass and V is the velocity), and more than 90% of gunshot wounds to the abdomen are associated with significant injuries Hollow viscera and large vessels are often involved, and solid organs such as the liver and the spleen may demonstrate burst injuries Therefore, laparotomy is mandated in virtually all gunshot wounds to the abdomen