Elsevier

Injury

Volume 43, Issue 9, September 2012, Pages 1442-1444
Injury

Laparoscopic treatment of gastric and duodenal perforation in children after blunt abdominal trauma

https://doi.org/10.1016/j.injury.2010.11.002Get rights and content

Abstract

Minimal invasive surgery has not yet gained wide acceptation for the care of patients that sustained an abdominal trauma. We describe the complete laparoscopic surgical treatment of two patients after a single blunt abdominal trauma. One patient sustained a handle bar injury and presented with a gastric perforation. The other sustained a duodenal rupture by falling on a sharp edge of a table. The patients were assessed and treated laparoscopically. The perforations were identified and closed. Both patients had an uneventful postoperative recovery. Therapeutic laparoscopic treatment of patients with upper gastrointestinal perforation is feasible. We would recommend this approach to experienced laparoscopic surgeons in hemodynamically stable patients.

Introduction

Diagnostic laparoscopy in patients with abdominal trauma is not only increasingly applied in adults, but also in children.5, 2 In penetrating abdominal trauma, the integrity of the peritoneum can be accurately established via this technique. Furthermore, in both penetrating and blunt abdominal trauma, intraperitoneal organ injury or perforation may be diagnosed. When damaged structures are found usually conversion to a laparotomy is advocated.14 In this paper we describe the complete laparoscopic surgical treatment of two children that sustained a single blunt abdominal trauma. One patient suffered from a gastric perforation while the other had a duodenal rupture.

Section snippets

Patient 1

A nine-year-old boy with no medical history sustained a mountain bike handle bar injury. Two hours after the accident he presented with complaints of worsening abdominal pain at a nearby first aid department. The patient had some bruising around the umbilicus and manifested tenderness of the upper abdomen. He was hemodynamically stable. Extra intestinal air and free intraperitoneal fluid was seen on an abdominal CT scan. No injury to any solid organs was found. He was referred to our department

Patient 2

A ten-year-old boy had lost his balance while standing on a triangular table at school and, as a result of falling on one of the corners, he sustained a blunt injury above the level of the umbilicus. One hour later he arrived at our emergency department. Upon examination some painful bruises were seen above the level of the umbilicus. He was hemodynamically stable. A CT scan of the abdomen showed signs of a perforation of the duodenum with extraluminal retroperitoneal air bubbles in this region

Discussion

In this paper we describe two young patients who sustained upper gastrointestinal injury after blunt abdominal trauma. In both patients we were able to diagnose and manage their injury laparoscopically. Both hemodynamically stable patients had evidence of intestinal injury without solid organ injury. According to the guidelines for diagnostic laparoscopy, published by the Society of American Gastrointestinal and Endoscopic Surgeons, diagnostic laparoscopy is contraindicated when there is

Conflict of interest statement

None of the authors has any conflict of interest regarding the data published in this paper. None of the authors has any financial interest in publishing the paper.

References (16)

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