Selective nonoperative management of penetrating abdominal injuries in children.

BACKGROUND: Nonoperative management of solid organ injuries caused by blunt abdominal trauma has been the standard care for many years. However, operative management is considered the standard care for penetrating abdominal trauma by most surgeons. The aim of this study was to assess the feasibility of selective nonoperative management of penetrating abdominal trauma in children.

METHODS: A total of 90 children suffering from penetrating abdominal trauma between 2003 and 2008 were evaluated. Patients who had hemodynamic instability or signs of bowel perforation underwent an immediate laparotomy. The remaining patients were observed with serial clinical examinations, radiologic evaluation, and hemoglobin level.

RESULTS: There were 76 boys and 14 girls. The mean age was 9.9 years (range, 1-16 years). The mechanism of injury was stab wound in 60 patients (67%) and gunshot in 30 (33%). The most commonly injured organ was bowel (51.7%). Omentum or bowel was eviscerated through wound in seven patients; none of these patients had organ injury. Although 51 (56.6%) were treated nonoperatively, 39 patients (43.4%) required surgical treatment (19 of 60 stab wound, 20 of 30 gunshot). Of the 39 patients who underwent surgery, 6 (15.3%) were found to have no significant organ injury during surgery. Of the all, 51 patients who were initially followed nonoperatively, two patients required surgery. There were two complications.

CONCLUSION: The majority of abdominal stab wound and many gunshot wounds can initially be managed nonoperatively in children, when there is no hemodynamic instability or signs of hollow viscus perforation.