Kane N M, Cronan J J, Dorfman G S, DeLuca F
Department of Diagnostic Radiology, Rhode Island Hospital, Brown University Program in Medicine, Providence 02902.
Pediatrics. 1988 Jul;82(1):11-5.
When indications for immediate laparotomy are not present, CT of the abdomen and pelvis can be used to evaluate pediatric blunt abdominal trauma. During 2-year period, the medical records and abdominal/pelvic CT scans of 100 consecutive pediatric patients who were evaluated for blunt abdominal trauma were retrospectively reviewed. The scans appeared normal for 73 children. Of these children, 30 had severe head injuries and a depressed sensorium. A total of 27 abdominal/pelvic CT scans were interpreted as abnormal. Findings included nine splenic fractures, six renal contusions, nine hepatic lacerations, one duodenal hematoma, one traumatic pancreatitis, four bony injuries, six miscellaneous abnormalities, and one intraperitoneal bleed. Only two of these 27 patients required abdominal surgery. The remaining 25 patients were treated conservatively based upon a stable clinical state and CT delineation of the extent of injury. No mortality resulted. CT is the radiographic examination of choice for hemodynamically stable pediatric patients with blunt abdominal trauma. CT provided a reliable adjunct examination technique when a physical examination could not be performed and a complete history could not be obtained. The extent of abdominal/pelvic injuries is well delineated and can often be followed by diagnostic imaging, usually allowing for conservative therapy.
当不存在立即进行剖腹手术的指征时，腹部和盆腔CT可用于评估小儿钝性腹部创伤。在两年期间，对100例连续接受钝性腹部创伤评估的小儿患者的病历和腹部/盆腔CT扫描进行了回顾性分析。73名儿童的扫描结果显示正常。在这些儿童中，30名有严重的头部损伤和意识不清。共有27例腹部/盆腔CT扫描被解读为异常。发现包括9例脾破裂、6例肾挫伤、9例肝裂伤、1例十二指肠血肿、1例创伤性胰腺炎、4例骨损伤、6例其他异常以及1例腹腔内出血。这27例患者中只有2例需要进行腹部手术。其余25例患者根据临床状态稳定以及CT对损伤程度的描绘而接受保守治疗。无死亡病例。对于血流动力学稳定的小儿钝性腹部创伤患者，CT是首选的影像学检查。当无法进行体格检查且无法获取完整病史时，CT提供了一种可靠的辅助检查技术。腹部/盆腔损伤的程度能够得到很好的描绘，并且通常可以通过诊断性影像学进行随访，这通常允许进行保守治疗。
