Blunt Trauma to the Abdomen
J. Alex Haller Jr MD1
1 Professor of Pediatric Surgery, of Pediatrics, and of Emergency Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Serious injuries remain the number one cause of death among American children. Major trauma is responsible for more than 50% of the mortality in children between the ages of 1 and 14 years. The majority of these life-threatening injuries result from blunt trauma rather than from penetrating injuries, which are much more common in adults. The most common causes of blunt trauma to children are: motor vehicle crashes when a child is either a pedestrian, bicycle rider, or automobile occupant; falls from windows or farm buildings and machinery; and house fires. Children die in motor vehicle crashes as a result of multiple systems injuries, of which the most serious is to the head.
Major blunt trauma to the abdomen frequently is associated with this series of injuries. This is a difficult injury to evaluate because often there are few signs of external damage to reflect the life-threatening trauma to internal abdominal organs. In addition, as noted previously, children commonly have associated head injuries and are unconscious at the time of evaluation, which makes early diagnosis and definitive treatment even more difficult, often resulting in disastrous delays in specific treatment.
The pathophysiology of blunt injuries to the abdomen results from energy transfer of compression and crush forces or from rapid deceleration/acceleration forces, which cause shearing stresses within the abdomen.
