1. Gareth Hosie Consultant Paediatric Surgeon 17th April 2015
Childhood trauma
Gareth Hosie
Consultant Paediatric Surgeon
17th April 2015

2. Trauma
Commonest cause of death in children > 1 yr

3. Causes of death
Head injury

4. Children
Relatively large head
Elastic thoracic cage
Tend to bounce

5. Abdominal trauma - penetrating

6. Blunt abdominal trauma

7. Blunt abdominal trauma

8. Blunt abdominal trauma

9. How often is surgical intervention required?

10.
9 year old girl
12.30 fell 12 – 15 ft from top of playground slide
Walked home
14.00 felt faint, 2 episodes of “shaking”
Mum brought her to A&E – arrived 15.30

11. Examination P 150 , BP 130/70 Pale, cool peripheries Normal neurology
Tender L side of abdomen and flank

12. 10ml /kg 0.9% NaCl

13. CT
BP ↓ 65mm Hg systolic
2nd bolus NaCl – BP 102 mmHg

15. Hb 8.3g/dl
Blood given

18. But …
Continued to ↓ Hb

21. 21.7.12 11 year old boy Riding BMX bike, doing jumps on skate park
Fell sidewards approx 1m
Handlebar injury to abdomen

22. Examination Haemodynamically stable Abrasion on epigastrium
Tender upper abdomen

23. Serum amylase 298 u/l

27. CT guided insertion of abdominal drain

28. Following month
Continued drain output

31.
5 year old boy
Chest and abdomen crushed by large marble fireplace

35. 1 week post trauma Laparoscopic insertion abdominal drain
2 litres of old blood / bilious fluid aspirated

36. 2 years post trauma

38. What about a ruptured spleen?

39. Ruptured spleen--when to operate?
J Pediatr Surg Jun;16(3):324-6.
Wesson DE, Filler RM, Ein SH, Shandling B, Simpson JS, Stephens CA.
Abstract
Sixty-three patients with splenic injuries were treated during a 5-yr period from The decision to operate was based on the patient's clinical course, not on the presence of splenic injury alone. Those who were stable on admission or after initial resuscitation were treated nonoperatively. This consisted of strict bed rest, nasogastric suction, and i.v. fluids--including blood--as required. Those who bled massively were operated on promptly. At operation, the spleen was repaired if possible or excised if damaged beyond repair. Forty patients were treated nonoperatively. Sixteen of these required blood transfusions (mean /- 5.3 ml/kg). One patient in this group developed a large defect on spleen scan at 3 wk post injury. There was no other morbidity and no mortality following nonoperative treatment. Nineteen required operation all within 16 hr of admission. Fifteen underwent splenectomy, 2 partial splenectomy, and 1 splenorrhaphy. In 1 the bleeding had stopped. All required blood before operation (mean / ml/kg). Seven in this group died (6 from head injuries and 1 from bleeding). Thus surgery was avoided in 2 out of 3 and the spleen saved in 3 out of 4 patients with documented splenic injuries. We believe that where adequate facilities exist nonoperative treatment of splenic injuries is both safe and effective. When bleeding is massive from the beginning or replacement requirements exceed 40 ml/kg, operation is indicated

40. Take home messages Children are resilient
Abdominal surgery rarely needed – and almost never in the early stages of trauma management