TITLE

Nonoperative Management of Blunt Splenic and Hepatic Trauma in the Pediatric Population: Significant Differences between Adult and Pediatric Surgeons?

AUTHOR(S)
Jacobs, Ira A.; Kelly, Kathleen; Valenziano, Carl; Pawar, Joanne; Jones, Carol
PUB. DATE
February 2001
SOURCE
American Surgeon;Feb2001, Vol. 67 Issue 2, p149
SOURCE TYPE
Academic Journal
DOC. TYPE
Article
ABSTRACT
Although operative management was the preferred method of treating blunt abdominal trauma in the past, recent literature and practice recommend a nonsurgical approach to most pediatric splenic and hepatic injuries. The majority of data supporting the safety and efficacy of this nonoperative approach are derived from university trauma programs with a pediatric center where care was managed by pediatric surgeons only. To evaluate the applicability of this approach in a regional trauma center where pediatric patients are managed by pediatric and nonpediatric surgeons we reviewed the experience at a Level II community trauma center. Fifty-four children (16 years of age or less) were admitted between April 1992 and April 1998 after sustaining blunt traumatic splenic and/or hepatic injuries. There were 37 (69%) males and 17 (31%) females; the average age was 11 years (range 4 months to 16 years). Of the 54 patients 34 (63%) sustained splenic injuries, 17 (31%) sustained hepatic injuries, and three (6%) sustained both splenic and hepatic injuries. All of these injuries were diagnosed by CT scan or during laparotomy. The average Injury Severity Score was 14.9 with a range from four to 57. Of the 47 patients initially admitted for nonoperative management one patient failed nonoperative management and required operative intervention. In our study 98 per cent (46 of 47 patients) of pediatric patients were successfully managed nonoperatively. Complications of nonoperative management occurred in two patients. Both developed splenic pseudocysts after splenic injury, which required later operative repair. These data are comparable with those from university trauma programs and confirm that nonoperative management is safe in a community trauma center. The majority of children with blunt splenic and hepatic trauma can be successfully treated without surgery, in a regional trauma center treated by nonpediatric trauma surgeons, if the decision is based on careful initial ev...
ACCESSION #
5180275

 

Related Articles

  • Possible treatment target found for main cause of severe liver disease in kids.  // Biomedical Market Newsletter;11/16/2011, Vol. 21, p677 

    The article reports on the findings of a study conducted by researchers led by Dr. Jorge Bezerra at Children's Hospital in Cincinnati, Ohio that a molecular signature for severe liver diseases in children can help develop better therapies that target the T helper cell 2 (Th2) immune system. It...

  • Potter type III cystic disease and pancreatic malignancies. Otani, Taiichi; Makuuchi, Masatoshi // Journal of Gastroenterology;2001, Vol. 36 Issue 6, p438 

    Editorial. Presents information on adult polycystic liver disease (APLD). Diseases which are usually complained by patients with APLD; Treatment methods for the disease; Proposed classifications of cystic disease.

  • hepatotherapy.  // Taber's Cyclopedic Medical Dictionary (2009);2009, Issue 21, p1063 

    An encyclopedia entry for "hepatotherapy," which refers to the treatment of liver diseases, is presented.

  • Changing Times and the Treatment of Liver Injury. Lucas, Charles E.; Ledgerwood, Anna M. // American Surgeon;Apr2000, Vol. 66 Issue 4, p337 

    We hypothesized that the frequency, diagnosis and treatment of liver injury have changed dramatically in the past 30 years. Patients with liver injuries treated in an urban level I trauma center were analyzed for three separate time periods, namely, 1969-1970, 1981-1982, and 1997-1998. The...

  • Studies on Standardization of Tephrosia purpurea Linn - an important Ayurvedic Drug. Singh, Arjun; Meena, Ajay Kr.; Rao, M. M.; Mishra, Sudeep; Padhi, M. M.; Babu, Ramesh // Asian Journal of Research in Chemistry;May2011, Vol. 4 Issue 5, p726 

    Herbal drugs are traditionally used in various parts of the world to cure different diseases. The present study has been conducted to evaluate the quality control parameters of the hydro alcoholic extracts of Tephrosia purpurea Linn ;an important Indian medicinal plant widely used in the...

  • Follow-Up Abdominal Computed Tomography after Splenic Trauma in Children May Not Be Necessary. Rovin, Joshua D.; Burns, R. Cartland; Rodgers, Bradley M.; Mcgahren, Eugene D.; Alford, Bennett A.; Mcilhenny, Joan // American Surgeon;Feb2001, Vol. 67 Issue 2, p127 

    Nonoperative management of splenic injuries in children is well accepted. However, the need for follow-up abdominal CT to document splenic healing has not been well studied. We retrospectively reviewed initial and follow-up abdominal CT examinations of pediatric patients admitted to our...

  • Prediction of early death after therapeutic hepatic arterial embolisation. Powell-Tuck, J.; McIvor, J.; Reynolds, K.W.; Murray-Lyon, I.M. // British Medical Journal (Clinical Research Edition);4/28/1984, Vol. 288 Issue 6426, p1257 

    Focuses on the death incidence after therapeutic hepatic arterial embolization. Factors affecting the risk of death; Identification of arterial occlusion after embolization; Analysis of serum alkaline phosphatase activity and albumin concentration for prediction of outcome.

  • Moving toward Laparoscopic Pyloromyotomy: An Initial Italian Experience and National Survey. Ceccanti, Silvia; Mele, Ermelinda; Frediani, Simone; Morgante, Debora; Iaconelli, Romina; Almenrader, Nicole; Passariello, Maurizio; Cozzi, Denis A. // American Surgeon;Sep2013, Vol. 79 Issue 9, p955 

    The article discusses the use of laparoscopic pyloromyotomy in a low-volume pediatric surgery center in Italy. It describes Italian pediatric surgeons' preferred practice patterns in managing infants with hypertrophic pyloric stenosis. The performance of laparoscopic pyloromyotomy via a small...

  • Splenic injuries in children: The challenges of non operative management in a developing country. Osifo, O. D.; Enemudo, R. E.; Ovueni, M. E. // Journal of Indian Association of Pediatric Surgeons;Oct-Dec2007, Vol. 12 Issue 4, p209 

    Aim: This is to report the challenges and experience gained with non operative management of splenic injuries in a developing country where sophisticated imaging facilities are either not available or exorbitantly expensive. Materials and Methods: All patients who presented with splenic injury...

Share

Read the Article

Courtesy of THE LIBRARY OF VIRGINIA

Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics