Hollow viscus injuries
Key points
Gastric
Blunt force rupture typically occurs at the greater curvature of a full stomach
Treatment involves washing out the abdomen, debriding tissue, and performing primary closure
Duodenal
Rupture often occurs where the duodenum crosses the spine (2nd or 3rd part)
Graded 1-5 based on severity
CT may reveal retroperitoneal air; use oral contrast CT if initial imaging is inconclusive
Haematomas are managed conservatively for 45 days (supported by Toronto and Houston cohorts)
Primary repair is common; severe injuries may require loop gastrojejunostomy or Roux-en-Y duodenojejunostomy if resection is necessary
Pancreaticoduodenectomy may be needed for the most severe injuries
Small Bowel and Colon
Primary repair is preferred if the injury is small
Resection and anastomosis without diversion are performed if the injury is large and the patient is haemodynamically stable
Superior Mesenteric Artery (SMA)
Requires urgent vascular repair but is often fatal
Rectal
Always consider safeguarding with anorectal injuries
Above the peritoneal reflection: Primary repair
Below the peritoneal reflection: Limited evidence; may require repair and covering colostomy
Bile Ducts
Managed with percutaneous drainage, ERCP, and stenting
Bladder
Extraperitoneal injury: Managed with catheterisation
Intraperitoneal injury: Requires laparotomy
Complications include low sodium and potassium levels if there is a leak
References
Holcomb and Ashcraft’s Pediatric Surgery, 7th edition, 2020, Chapter 16 Abdominal and Renal Trauma
Walk, Ryan M, et al. "Duodenal Injury." Pediatric Surgery NaT, American Pediatric Surgical Association, 2020. Pediatric Surgery Library, www.pedsurglibrary.com/apsa/view/Pediatric-Surgery-NaT/829092/all/Duodenal_Injury.