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TABLE 103.2 INDICATIONS FOR IMMEDIATE LAPAROSCOPY OR LAPAROTOMY FOR CHILDREN WITH ABDOMINAL TRAUMA Multisystem injuries with indications for craniotomy in the presence of free peritoneal fluid on ultrasonography, or strong historical, physical, or radiographic evidence of abdominal injury Persistent and significant hemodynamic instability with evidence of abdominal injury in the absence of extra-abdominal injury Penetrating wounds to the abdomen Pneumoperitoneum Significant abdominal distention associated with hypotension CLINICAL PEARLS AND PITFALLS The administration of IV contrast is essential for abdominal CT for the evaluation of an injured child Abdominal CT has low sensitivity for small gastrointestinal perforations and pancreatic injury Judicious use of the combination of physical examination, laboratory screening values, and CT scanning is indicated for the stable patient Imaging protocols that use the lowest possible dose of radiation exposure for the child should be utilized A FAST examination is not sufficient to exclude intra-abdominal injury EMERGENT VERSUS SELECTIVE LAPAROSCOPY OR LAPAROTOMY Goals of Treatment The indications for immediate laparoscopy or laparotomy are limited in blunt abdominal trauma in children ( Table 103.2 ) In most cases of abdominal trauma in children ( Fig 103.2 ), emergency laparotomy is not necessary and further diagnostic studies direct either elective (selective) laparoscopy or observation and monitoring In the case where there is concern for an intra-abdominal injury in a stable child, laparoscopy is a useful diagnostic and potentially therapeutic tool, and allows the trauma team to rapidly and safely “know” if there is an injury