Abstract
This study evaluates the safety and role of laparoscopy in the diagnosis of blunt abdominal trauma in children. Laparoscopy was performed in five patients aged 3 to 13 years because of persistent abdominal pain after blunt trauma. A laparotomy was not indicated from the physical examination, laboratory data, or radiologic findings. With the patient under general anesthesia, a 10-mm trocar was inserted through the umbilical fossa and the intra-abdominal organs were observed for 10–60 min under an insufflation pressure of 10–12 mmHg. The patients remained hemodynamically stable without pneumothorax development. Three patients underwent laparatomies: one, who had blood in the omental sac, had a duodenal injury with hemorrhagic necrosis and underwent a resection; one with ascites and high amylase levels had an injury of the main pancreatic duct and underwent resection of the pancreatic tail; and one who had fresh blood in the upper abdomen and Douglas' pouch had a splenic hemorrhage and underwent hemostasis. The other two had serous or serosanguinous ascites and recovered without surgery. In patient 1, the same amount of information might have been obtained from a barium study. In patient 2, the pancreatic transection might have been diagnosed from ascites shown on serial computed tomograms. Patient 3 might also have been treated successfully non-surgically. It hus appears that laparoscopy may be a safe diagnostic method for blunt abdominal trauma in children, however, this small series has yielded insufficient information to assess its usefulness in making the diagnosis and the decision for laparotomy. Further studies are required to ascertain whether it will make any significant difference in the form of management.
Similar content being viewed by others
References
Berci G, Sackier JM, Paz-Partlow M (1991) Emergency laparoscopy. Am J Surg 161: 332–335
Brandt CP, Priebe PP, Jacobs DG (1994) Potential of laparoscopy to reduce non-therapeutic trauma laparotomies. Am Surg 60: 416–420
Carnevale N, Baron N, Delany HM (1977) Peritoneoscopy as an aid in the diagnosis of abdominal trauma: a preliminary report. J Trauma 17: 634–641
Graham JM, Pokorny WJ, Mattox KL, Jordan GL (1978) Surgical management of acute pancreatic injuries in children. J Pediatr Surg 105: 158–163
Iwase K, Takenaka H, Yagura A, Ishizuka T, Ohata T, Oshima S (1993) Hemodynamic alterations during laparoscopic cholecystectomy. Dig Surg 10: 5–9
Koehler RH, Smith RS, Fry WR (1994) Successful laparoscopic splenorrhaphy using absorbable mesh for grade III splenic injury: report of a case. Surg Laparosc Endose 4: 311–315
Leape LL, Ramenofsky ML (1980) Laparoscopy in children. Pediatrics 66: 215–220
Liu SY, Leighton TA, Davis I, Klein S, Lippmann M, Bongard FS (1991) Cardiopulmonary effects of laparoscopic cholecystectomy. J Laparoscop Surg 5: 241–246
Rescorla FJ, Plumley DA, Sherman S, Sherer LR, West KW, Grosfeld JL (1995) The efficacy of early ERCP in pediatric pancreatic trauma. J Pediatr Sung 30: 336–340
Rossi P, Mullins D, Thal E (1993) Role of laparoscopy in the evaluation of abdominal trauma. Am J Surg 166: 707–710
Schrenk P, Woisetsschlager R, Wayand WU (1994) Diagnostic laparoscopy: a survey of 92 patients. Am J Sung 168: 348–351
Sivit CJ, Eichelberger MR, Taylor GA, Bulas DI, Gotschall CS, Kushner DC (1992) Blunt pancreatic trauma in children: CT diagnosis. Am J Radiol 158: 1097–1100
Smith SD, Nakayama DK, Gantt N, Rowe MI (1988) Pancreatic injuries in childhood due to blunt trauma. J Pediatr Surg 23: 610–614
Tobias JD, Holcomb GW, Brock JW, Deshparde JK, Lowe S, Morgan WM (1995) Cardiorespiratory changes in children during laparoscopy. J Pediatr Surg 30: 33–36
Townsend MC, Flancbaum L, Choban PS, Cloutier CT (1993) Diagnostic laparoscopy as an adjunct to selective conservative management of solid organ injuries after blunt abdominal trauma. J Trauma 35: 647–651
Waldschmidt J, Schier F (1991) Laparoscopic surgery in neonates and infants. Eur J Pediatr Surg 1: 145–150
Wittgen CM, Andrus CH, Fitzgerald SD, Baudendistel LJ, Dahms TE, Kaminski DL (1991) Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy. Arch Surg 126: 997–1001
Wood D, Berci G, Morgenstern L, Paz-Partlow M (1988) Minilaparoscopy in blunt abdominal trauma. Surg Endosc 2: 184–189
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hasegawa, T., Miki, Y., Yoshioka, Y. et al. Laparoscopic diagnosis of blunt abdominal trauma in children. Pediatr Surg Int 12, 132–136 (1997). https://doi.org/10.1007/BF01349980
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01349980