Trauma is the leading cause of death in children over 1 year of age and causes approximately 22,000 deaths per year in the US. Most often they are caused by a car accident, but now the main cause of death among urban teenagers is homicide. Given the smaller size of the body, children are characterized by polysystemic injury. Therefore, trauma to the abdomen is often accompanied by damage to poorly protected parenchymal organs.

Abdominal injury in children

Injuries to parenchymal organs (liver and spleen) predominate, and most abdominal injuries in children result from blunt forceful impact, although penetrating injuries are becoming more common. Penetrating lesions in children manifest themselves in the same way as in adults. However, the effects of blunt abdominal are treated differently. Although there are always exceptions, most parenchymal organ injuries in children are treated nonoperatively. In case of failure of non-surgical treatment of trauma to the spleen, all efforts are directed to the preservation, rather than removal of the damaged organ (given the high mortality rate due to post-splenectomy sepsis).

Improper use of seat belts increases the risk of a specific type of injury in children, including abdominal wall injuries, intestinal hemorrhages or perforations, and lumbar spine injuries. This combination of injuries is seen primarily in young children who are tied to the seat with straps that are designed for adults.

When diagnosing, the possibility of violence as a source of abdominal trauma is always taken into account. Punching to the abdomen can cause life-threatening ruptures of the liver and spleen, trauma to the pancreas, and ruptures of the intestine.

Treatment of abdominal injuries

Treat abdominal injuries in children in accordance with the principles developed in special medical programs. Initial treatment focuses on basic life support activities such as access to air, breathing, and circulation (primary interventions). In traumatized children, especially with simultaneous head injury, special attention is paid to the protection of the cervical spinal cord. After the primary measures, the doctor proceeds to the second stage - the search for damage to specific organ systems.

In addition to a thorough clinical examination, the following diagnostic methods are used to assess abdominal trauma: computed tomography, ultrasound, diagnostic peritoneal lavage. Although each of these methods has its ardent proponents, but they are considered auxiliary, they have their pros and cons.

Meckel diverticulum in children

Meckel's diverticulum occurs in 2% of the population, with a male to female ratio of 2:1, can contain two types of tissue (gastric and pancreatic), is 2 inches (5.1 cm) long, classically located within 2 feet (60 cm) of ileocecal junction and causes symptoms in 2% of individuals who have it. Complications are associated primarily with the presence of gastric mucosa in the diverticulum, most often hemorrhages and perforations occur. The typical initial symptom of Meckel's diverticulum in children is massive, painless rectal bleeding; in other cases, diverticulitis and intussusception occur, in which Meckel's diverticulum becomes the leading point. In addition, other foreign bodies can be wedged into the diverticulum, causing the need for their surgical removal.

The initial evaluation and management of Meckel's diverticulum in children includes supportive care, often requiring fluid rehydration and blood transfusion. Barium examination is usually ineffective for detecting diverticulum, radioisotope scintigraphy is the method of choice. The accuracy of scintigraphy for establishing Meckel's diverticulum examinations is approximately 95%. Pseudo-negative results occur if the diverticulum is actively bleeding or contains only pancreatic tissue.