Penetrating abdominal injuries in children: a study of 33 cases

Abstract

Background: Trauma is gradually becoming a major cause of disability and it can be of any form, physical or emotional. For the surgeon the physical form is of major interest, especially its causes and incidence, which can be influenced by environmental or social factors.

Aim: The aim of this work was to study the incidence, etiology, principles of management and outcome of children with penetrating abdominal injuries.

Materials and methods: This was a 2-year prospective study of 33 children aged 0–15 years with penetrating abdominal injuries at the University of Maiduguri Teaching Hospital in northeast Nigeria. Information obtained included the following: the patient’s biodata, mechanism of injury, time of presentation to the Accident and Emergency Department after the injury, haemodynamic status at presentation, presence or absence of abdominal organ evisceration, presence or absence of associated injuries, the timing of surgery, intraoperative findings, the type of surgical procedure and outcome.

Results: Thirty-three (31.4%) children [of whom 24 (i.e. 72.7%) were from the rural areas] of 105 children with trauma-related injuries had penetrating abdominal injuries. The male : female ratio was 3 : 1, and the mean age ± SD was 2.30± 0.81 years. There were 15 (45.4%) children with gunshot wounds, 11 (33.3%) with bomb blast wounds, three (9.1%) with impalement injuries and two (6.1%) with arrow injuries. Fourteen (42.4%) patients had abdominal organ evisceration; of them, nine were as a result of gunshot injuries. Routine exploratory laparotomy was carried out in all 33 patients. Seven (21.2%) were operated on with simultaneous resuscitation in the immediate laparotomy group, and 26 (78.8%) underwent delayed laparotomy. There was a negative laparotomy in four (12.1%) patients, two of whom had only omental evisceration with no other accompanying visceral injuries, and two without evisceration. Three (9.1%) patients died after developing enterocutaneous fistula, compartment syndrome and sepsis.

Conclusion: There were more cases of penetrating abdominal injuries among boys and children from the rural areas than in those from urban areas.

Keywords: evisceration, exploratory laparotomy, penetrating abdominal injury