Blunt Abdominal Trauma in Children Problems and Solutions Rizwan Ahmad Khan Shagufta Wahab Editors 123 Blunt Abdominal Trauma in Children Rizwan Ahmad Khan • Shagufta Wahab Editors Blunt Abdominal Trauma in Children Problems and Solutions Editors Rizwan Ahmad Khan Shagufta Wahab Department of Pediatric Surgery Department of Radio-diagnosis Jawaharlal Nehru Medical College Jawaharlal Nehru Medical College Aligarh Muslim University Aligarh Muslim University Aligarh Aligarh Uttar Pradesh Uttar Pradesh India India ISBN 978-981-13-0691-4 ISBN 978-981-13-0692-1 (eBook) https://doi.org/10.1007/978-981-13-0692-1 Library of Congress Control Number: 2018945866 © Springer Nature Singapore Pte Ltd. 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by the registered company Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Foreword As a pediatric surgeon involved with medical teaching in one of the most premier medical institutes of India, it cannot be more gratifying for me to learn that one of my bright students is bringing out a detailed in-depth book on pediatric abdominal trauma—one of the most frequently encountered scenarios in a casualty and also one of the most challenging. My association with Dr. Rizwan goes back to 2005 when he joined our institute as an M.Ch student and impressed us with his dedication and hard work. It was dur- ing one of our casual discussions about 2 years ago that he and Dr. Shagufta felt about the lack of a detailed research publication on pediatric trauma. Most of the available publications have scratched the topic superficially only and detailed analy- sis of the demographics, etiology, prevention, initial presentation, clinical evalua- tion, imaging, management, and finally psychological post-trauma management has been lacking. They shared their experience with their colleagues in other medical institutes and finally came out with this wonderful book on pediatric abdominal trauma after 2 years of painstaking work, and I was really impressed with the exten- siveness of the draft. As many medical authors realize, producing a book is a patient, tiresome, and lonely experience and many a times wonderful projects are lost along the way. But this project saw the light of day by the Grace of the Almighty and the efforts of the authors and editors—conceptualizing, drafting, redrafting, revising… the list is long. I congratulate them all for this wonderful work on pediatric abdomi- nal trauma, which I hope will be of great help to all medical professionals and will guide better and complete patient management. After more than a decade, it has been a wonderful experience to get associated with your former student and I am indeed honored to write the foreword for this book and wish it all the success. Ram Samujh Department of Pediatric Surgery Advanced Pediatric Centre, Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh, India v Preface Trauma constitutes a major part of everyday emergency that surgeons face all over the world. In today’s world, where violence, intentional or unintentional, is increas- ingly getting common and prevalent, children being the vulnerable populace are becoming the innocent victims in alarmingly large numbers. Penetrating trauma being easily identifiable is quickly diagnosed and also identi- fied by nonmedical personnel as well as the general population and compels urgent and adequate measures. The blunt trauma to abdomen is not overtly visible and therefore gives a false impression to nonprofessionals as well as the general popula- tion that the child has “escaped unhurt.” It also tests the clinical acumen of the best pediatric surgeons and radiologists as well. When we decided to write on the diagnosis and management of blunt trauma abdomen in children, we realized that the topic, although niche, is quite exhaustive. However, such a book dealing with epidemiological aspects, risk factors, clinical and imaging aspect of injuries, their complications, and management could fulfill the existing gaps and provide a comprehensive knowledge on management aspects of blunt abdominal trauma in children. In children, blunt nature of injuries is much more common than penetrating type. And 5–10% of children affected with blunt abdominal trauma sustain some form of intra-abdominal injury. Even among pediatric age groups (infants vs. school-aged children), there may be different mechanisms and presentation. Therefore, the prob- lems and strategies of blunt trauma in adults cannot be extrapolated to pediatric age group because of variable anatomical, physiological, mechanical, and clinical aspects. In fact, there are disparities based on socioeconomic and ethnic aspects also. Thus, clinical approach to a child with blunt abdominal trauma is nothing short of opening a Pandora’s Box. It requires specialized and standardized methodology so as to give the best possible trauma care to the children. With these points in mind, we undertook the task of bringing out this multi- authored book by the experts in their fields. The book consists of 14 chapters begin- ning with introduction and epidemiology of pediatric abdominal trauma, various steps in accurate diagnosis, management both surgical and nonsurgical, complica- tion, and sequelae of the management. Finally, we also included a full-length chap- ter on psychological rehabilitation of these trauma patients and their families. The best aspect of this book is that we have tried to amalgamate the old knowledge and vii viii Preface wisdom with updated and latest developments in the field of study because of which there might be some repetitions along the text. We have incorporated an elaborate bibliography to assist the reader for further reading and reference. Our book not only covers pediatric blunt abdominal trauma and its management but also covers issues concerning trauma prevention and the post-trauma psycho- logical issues in children and their families. It provides a comprehensive and holis- tic approach very much needed in pediatric care. The editors wish that this book be useful for clinicians, radiologists, pediatri- cians, primary caregivers, pediatric surgeons, trauma trainees, and surgical as well as pediatric surgical residents and pediatric clinical psychologists. In the end, we would like to acknowledge the efforts of Springer Nature and Springer personnel for their expert advice and guidance in producing this book. We thank families of our contributors and our family for their unstinted support and patience. Last but not least, we feel gratitude for our “young patients” who were the cornerstone of this idea during the course of their care and hospital stay, and we sincerely hope and wish that our book will be helpful in improving the care of these very children. Aligarh, India Rizwan Ahmad Khan Aligarh, India Shagufta Wahab Contents 1 Introduction and Epidemiology of Abdominal Trauma in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Nitin Borkar 2 Injury and Risk of Abdominal Trauma in Children . . . . . . . . . . . . . . . 7 Rizwan Ahmad Khan and Shagufta Wahab 3 Prevention of Paediatric Abdominal Trauma . . . . . . . . . . . . . . . . . . . . . 11 Neeti Goswami 4 Post-traumatic Stress Disorder in Children . . . . . . . . . . . . . . . . . . . . . . 19 Deoshree Akhouri 5 Prehospital and Initial Trauma Care . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Nidhi Sugandhi 6 Assessment of a Child with Abdominal Trauma . . . . . . . . . . . . . . . . . . 41 Rizwan Ahmad Khan 7 Imaging in Pediatric Abdominal Trauma . . . . . . . . . . . . . . . . . . . . . . . . 53 Shagufta Wahab 8 Interventional Imaging in Pediatric Abdominal Trauma . . . . . . . . . . . 67 Shagufta Wahab 9 Anesthetic and Critical Care Considerations in Children with Abdominal Trauma . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 Lalit Gupta and Bhavna Gupta 10 Blunt Solid Organ Injuries in Children . . . . . . . . . . . . . . . . . . . . . . . . . 89 Rizwan Ahmad Khan 11 Genitourinary Injuries in Pediatric Blunt Trauma . . . . . . . . . . . . . . . . 97 Tanveer Roshan Khan and Rizwan Ahmad Khan ix x Contents 12 Blunt Bowel Injuries in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Rizwan Ahmad Khan 13 Abdominal Wall Injuries in Blunt Trauma . . . . . . . . . . . . . . . . . . . . . . . 113 Manal Mohd Khan 14 Other Blunt Injuries in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Rizwan Ahmad Khan and Shagufta Wahab About the Editors Rizwan Ahmad Khan is an associate professor and head of the Department of Pediatric Surgery, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. He received his superspecialization in pediatric surgery from the PGI, Chandigarh. His areas of interest are pediatric trauma, pediatric urology including pediatric hernia, hydrocele, undescended testes, ureteropelvic junction obstruction, posterior urethral valves, and congenital hydrocephalus. He has published more than 50 articles in peer-reviewed international and national journals of pediatric surgery and two book chapters. He is a member of various pediatric surgery bodies of India and abroad and serves as a reviewer for many prominent journals of pediatrics. Shagufta Wahab holds an M.D. in radiodiagnosis and is a consultant radiologist currently working as an associate professor at the Department of Radiodiagnosis, Jawaharlal Nehru Medical College, Aligarh Muslim University, Aligarh. She has published more than 40 papers related to radiodiagnosis in various peer-reviewed national and international journals, as well as a handbook. Her main field of research is pediatric and women’s imaging and MRI, with an emphasis on newer techniques like MR spectroscopy, diffusion and perfusion imaging, MR urography, and MR angiography. She is an active member of various international and national radio- logical societies. xi