Emergency Department Laparoscopic Evaluation of Blunt Abdominal Trauma in Children: Preliminary Results

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Abstract
Background and Purpose: Severely injured children who are sent for a CT scan are at risk of deteriorating while away from immediate medical management. We ascertained the safety and accuracy of emergency department laparoscopy in the evaluation of blunt abdominal trauma. Patients and Methods: Five children ages 2 to 7 years (mean 4.4 years) who had suffered closed head injuries underwent laparoscopy in the emergency department over a 4-month period. All were intubated because of depressed consciousness (Glasgow Coma Scale ≤8) and underwent CT scanning of the head and abdomen prior to laparoscopy by the open technique through a 3-mm umbilical port with a pneumoperitoneum of 14 mm Hg. Visibility was optimized by manual rotation of the patient, and blood pressure, EKG, pulse oximetry, and arterial blood gases were monitored. The laparoscopist did not know the results of the CT scan. Results: The liver, spleen, diaphragm, bladder, and large and small bowel were easily visible in all patients. None of the patients demonstrated hemoperitoneum or other abdominal injury, and these findings were corroborated by CT. In one patient in whom a diaphragmatic rupture was suspected from the CT scan, laparoscopy showed the diaphragm to be intact. No patient deteriorated or showed hemodynamic instability during laparoscopy. The time needed for laparoscopy shortened over the series from 65 minutes to 17 minutes. Conclusion. Emergency-department laparoscopy can be a safe, rapid, and precise way to evaluate the abdomen of children with serious head injury.

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