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requiring surgical treatment Further, if there is a major injury identified that cannot be treated laparoscopically, the incision can easily be converted to a laparotomy for wider exposure The indications for emergent laparoscopy or laparotomy in children with penetrating trauma are illustrated in Figure 103.3 CLINICAL PEARLS AND PITFALLS Most children with blunt abdominal trauma require only in-hospital observation and monitoring after delineation of the site and extent of their injury by abdominal CT Hemodynamically unstable children with evidence of an intraabdominal source of bleeding require emergent surgical exploration Any gunshot wound to the abdomen mandates immediate exploration Other types of penetrating wounds in the presence of unexplained hemodynamic compromise, evisceration, pneumoperitoneum, or any evidence of violation of the peritoneum require prompt laparotomy FIGURE 103.3 Management of penetrating abdominal trauma