복부 둔상을 입은 소아에서의 비수술적 치료

Nonoperative Management of Children with Blunt Abdominal Trauma

The management of twenty-two children with blunt abdominal trauma was analyzed. Nineteen cases had intraabdominal injuries; involving the spleen in 7 cases, the liver in 5, the pancreas in one and the bladder in one. There were five case multiple intraabdominal organ injuries. Seventeen out of 19 patients were treated non-operatively, but one was operated upon later because of delayed bleeding. Thirteen patients required transfusion in the non operated group, the mean values of the Pediatric Trauma Score (PTS) was 11.3. The mean lowest hemoglobulin(LHb) was 9.1 g/dL. The mean value of three cases with extraabdominal injuries were 9.0 and 8.3 g/dL respectively. The average amount of transfusion was 17.3 ml/kg. In the operated group, 2 cases were transfused an average of 139.8 ml/kg and their mean PTS was 5 and LHb was 6.6 g/dL. In one out of 16 non-operated cases, intrahepatic hematoma developed and but resolved conservatively. However, two out of 3 operated cases suffer complications such as an intubation granuloma and an intraabdominal abscess with wound dehescence. In conclusion, non-operative management in child with blunt abdominal trauma was safe in Grade I and II solid organ injuries. The decision for operation should be based on the hemodynamic stability after initial resuscitation including transfusion.