Ameh E A, Mshelbwala P M
Division of Paediatric Surgery, Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Niger J Clin Pract. 2009 Jun;12(2):192-5.
The management of abdominal trauma (particularly blunt trauma) has undergone tremendous revolution in the last 30 years with significant reduction in morbidity and mortality in developed countries. The aim of this report is to highlight the challenges of managing abdominal trauma in children in Nigeria based on our experience in Zaria, northern Nigeria.
This is a retrospective review of 82 children managed for abdominal trauma from 1991 2002 at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria. Information regarding demographics, mechanism of injury, haemodynamic status at presentation, clinical and radiologic evaluation, management, intraoperative findings and outcome, were extracted from case notes, operation notes and discharge summary notes.
Fifty seven (69.5%) children had blunt trauma, mostly from traffic accidents (32, 57%) and falls (20, 36%), and 25 (30.5%) penetrating trauma mainly from falls onto sharp objects (7 of 18 patients) and animal-related injuries (5 of 18 patients). In the management of those with blunt trauma, advanced imaging modalities were usually not available and this resulted in an unnecessary laparotomy rate of 51% (laparotomy considered unnecessary because the patients remained haemodynamically stable after resuscitation and any intraperitoneal bleeding had stopped by the time oflaparotomy and no active operative measure was required to control bleeding). The management of penetrating trauma was more straightforward as this was guided by evidence of peritoneal penetration. Mortality from blunt trauma was 14.5% (8 of 55 patients) from exsanguinations before surgery 2, gastric perforation 3, hepatic laceration 2 and splenic injury one. Mortality from penetrating trauma was 12% (3 of 25 patients) from tetanus, overwhelming infection and haemorrhage respectively. The overall mortality from abdominal injury was 13.8% (11 of 80 patients) and were mostly avoidable if the patients presented early, and received some resuscitation before arrival at our hospital.
The management of blunt abdominal trauma in children in Nigeria is faced with several challenges, which are mainly absence of an organised trauma system and lack of appropriate facilities. These need to be addressed in order to improve the care of these injuries.
在过去30年中，腹部创伤（尤其是钝性创伤）的处理发生了巨大变革，发达国家的发病率和死亡率显著降低。本报告旨在根据我们在尼日利亚北部扎里亚的经验，强调尼日利亚儿童腹部创伤处理面临的挑战。
这是一项对1991年至2002年在尼日利亚扎里亚的阿哈穆杜·贝洛大学教学医院接受腹部创伤治疗的82名儿童进行的回顾性研究。从病历、手术记录和出院总结记录中提取了有关人口统计学、损伤机制、就诊时的血流动力学状态、临床和放射学评估、处理、术中发现及结果等信息。
57名（69.5%）儿童为钝性创伤，主要源于交通事故（32例，57%）和跌倒（20例，36%）；25名（30.5%）为穿透性创伤，主要源于跌倒在尖锐物体上（18例患者中的7例）和与动物相关的损伤（18例患者中的5例）。在钝性创伤患者的处理中，通常无法获得先进的影像学检查手段，这导致不必要的剖腹手术率达51%（剖腹手术被认为不必要，因为患者复苏后血流动力学保持稳定，且在剖腹手术时腹腔内出血已停止，无需采取积极的手术措施控制出血）。穿透性创伤的处理则更为直接，因为这由腹膜穿透的证据来指导。钝性创伤导致的死亡为14.5%（55例患者中的8例），原因分别为术前失血2例、胃穿孔3例、肝裂伤2例和脾损伤1例。穿透性创伤导致的死亡为12%（25例患者中的3例），原因分别为破伤风、严重感染和出血。腹部损伤导致的总体死亡率为13.8%（80例患者中的11例），如果患者能早期就诊并在抵达我院前接受一些复苏治疗，这些死亡大多是可以避免的。
尼日利亚儿童钝性腹部创伤的处理面临若干挑战，主要是缺乏有组织的创伤系统和适当的设施。为改善这些损伤的治疗，需要解决这些问题。
