Blunt abdominal trauma with intra-abdominal hemorrhage (bleeding in the abdomen) and/or organ injury is always an indication for surgical intervention. In the case of severe bleeding, surgery must be performed immediately, whereas in the case of minor bleeding, it is possible to wait initially – provided that blood pressure and pulse are stable – to see whether the bleeding stops spontaneously.
In the case of perforating abdominal injuries, a laparotomy (opening of the abdominal cavity) should always be performed to identify even minor injuries.
If the bleeding can be stopped in time and the blood loss with its consequences has been absorbed, the injuries usually heal without consequences.
In children, the following factors are most likely to indicate intra-abdominal injuries (injuries in the abdominal cavity):
- Abdominal tenderness
- Femur fracture (thigh bone)
- Low systolic blood pressure
- Initial (initial) hematocrit < 30%.
- Hematuria (blood in the urine) [> 5 erythrocytes/facial area].
- Increase in liver parameters
- Alanine aminotransferase [> 125 U/l]
- Aspartate aminotransferase (AST) [> 200 U/l]
In the setting of blunt abdominal trauma in children with isolated parenchymal organ lesions, conservative therapy can be used in the majority of cases (“nonoperative management”), provided the child has a stable circulation (“hemodynamic stability”). Circulatory stability can be promoted or maintained by infusion therapy, administration of catecholamines (e.g., norepinephrine), and transfusion of red blood cell concentrations. If the red blood cell requirement is > 25 ml/kg body weight within the first two hours after the accident or > 40 ml/kg body weight within the first 24 hours, the patient is no longer considered circulatory stable. Surgical intervention is then usually required and must be performed as soon as possible.
