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Injuries are generally classified based on mechanism as either blunt or penetrating. Each has a different method of evaluation and treatment.
In blunt injuries, solid organs are commonly injured with acceleration/deceleration injuries (i.e., motor vehicle collisions [MVC], falls from height) and crush injuries. Blunt injuries are associated with greater mortality than penetrating ones. The spleen is the most commonly injured solid organ, followed by the liver.
A stab wound, one such penetrating injury, is less likely to cause intra-abdominal injury and penetrate the peritoneum requiring surgical intervention when compared with projectile wounds.
This chapter discusses the diagnosis, evaluation and management of solid organ abdominal trauma. It presents special circumstances which make diagnosis and management of solid organ abdominal trauma difficult in pediatric patients. The primary survey for solid organ abdominal trauma should be aimed at determining which patients need immediate laparotomy versus those that are stable for further diagnostic workup. Vital signs provide a key to hemodynamic stability. Unstable patients with blunt or penetrating trauma to the abdomen require immediate laparotomy. All patients after significant trauma, both blunt and penetrating, should receive screening AP chest radiography. Given small anteroposterior diameter and developing abdominal musculature, children are more vulnerable to blunt forces. The most likely reason for sudden deterioration in a trauma patient with solid organ injury is hemorrhagic shock; therefore more aggressive resuscitation has to be considered and the process to get patient to the OR for laparotomy is facilitated.