Zusammenfassung
Verletzungen durch ein stumpfes Bauchtrauma werden bei Kindern vorrangig konservativ
behandelt. Die Herausforderung an den Diagnostiker besteht in der sicheren und
schnellen Erfassung der operationsbedürftigen Befunde, ohne die Kinder einer zu
hohen Strahlenexposition auszusetzen. Hauptuntersuchungsmethoden sind die Sonographie
als Basisdiagnostik noch im Schockraum und die kontrastmittelverstärkte Computertomographie
des Abdomens bei kreislaufstabilen Patienten. In dieser Arbeit werden die
diagnostischen Methoden vorgestellt, ihr Stellenwert in der praktischen Anwendung
erläutert und Strategien für den Untersuchungsablauf zusammengefasst.
Abstract
Children with abdominal injuries after blunt trauma can be managed non operatively
in most cases. Rapid diagnosis is essential to select those patients who need
immediate operation. Diagnostic methods of choice are ultrasonography, already
performed in the emergency setting and contrast enhanced CT of the abdomen in
hemodynamically stable patients. This work discusses the different diagnostic
strategies and their use in the clinical practice.
Keywords
Abdominal blunt trauma - children, abdominal ultrasonography - computed tomography
- imaging findings
Literatur
- 1
Gaines B A. et al .
Duodenal injuries in children: beware of child abuse.
J Pediatr Surg.
2004;
39
600-602
- 2
Cloutier D R. et al .
Pediatric splenic injuries with a contrast blush: successful nonoperative management
without angiography and embolization.
J Pediatr Surg.
2004;
39
969-971
- 3
Paddock H N. et al .
Management of blunt pediatric hepatic and splenic injury: similar process, different
outcome.
Am Surg.
2004;
70
1068-1072
- 4
Tsugawa K, Koyanagi N, Hashizume M. et al .
New insight for management of blunt splenic trauma: significant differences
between young and elderly.
Hepatogastroenetrology.
2002;
49
1144-1149
- 5
Taylor G A, Kaufman R A, Sivit C J.
Active hemorrhage in children after thoracoabdominal trauma: clinical and CT
features.
Am J Roentgenol.
1994;
162
401-404
- 6
Taylor G A, Sivit C J.
Computed tomography imaging of abdominal trauma in children.
Semin Pediatr Surg.
1992;
1
253-259
- 7
Richards J R, Knopf N A, Wang L, McGahan J P.
Blunt Abdominal trauma in Children: Evaluation with Emergency US.
Radiology.
2002;
222
749-754
- 8
Tas F. et al .
The efficacy of ultrasonography im hemodynamically stable children with blunt
abdominal trauma: a prospective comparison with computed tomography.
Eur J Radiol.
2004;
51
91-96
- 9
Frush D P, Slack C C, Hollingsworth C L. et al .
Computer-simulated radiation dose reduction for abdominal multidetector CT of
pediatric patients.
Am J Roentgenol.
2002;
179
1107-1113
- 10 Bildgebende Diagnostik beim Kind. Strahlenschutz, Rechtfertigung und Effektivität.
Empfehlung der Strahlenschutzkommission. Verabschiedet am 11./12. Juli 2006
- 11
Gress H, Nömayr A, Wolf H. et al .
Dose reduction in CT of children by attenuation-based on-line modulation of
tube current (CARE Dose).
Eur Radiol.
2002;
12
1571-1576
- 12
Huda W.
Dose and image quality in CT.
Pediatr Radiol.
2002;
32
709-713
- 13
Mizzi A, Shabani A, Watt A.
The role of follow-up imaging in pediatric blunt abdominal trauma.
Clin Radiol.
2002;
57
908-912
- 14
Yardeni D. et al .
Splenic artery embolization for post-traumatic splenic artery pseudoaneurysm
in children.
J Trauma.
2004;
57
404-407
- 15
Lutz N. et al .
The significance of contrast blush on computed tomography in children with splenic
injuries.
J Pediatr Surg.
2004;
39
491-494
- 16
Resende V. et al .
Helical computed tomography characteristics of splenic and hepatic trauma in
children subjected to nonoperative treatment.
Emerg Radiol.
2002;
9
309-313
- 17
Minarik L, Slim M, Rachlin S. et al .
Diagnostic imaging in the follow-up of nonoperative management of splenic trauma
in children.
Pediatr Surg Int.
2002;
18
429-431
- 18
Shah P, Applegate K E, Buonomo C.
Stricture of the duodenum and jejunum in an abused child.
Pediatr Radiol.
1997;
27
281-283
- 19
Henker J, Kaulisch A, Laaß M W.
Akute Pankreatitis im Kindesalter.
Monatsschrift Kinderh.
2005;
154
245-250
- 20
Jobst M A, Canty T G, Lynch F P.
Management of pancreatic injury in pediatric blunt abdominal trauma.
J Ped Surg.
1999;
34
818
- 21
Emery K H.
Lap belt wing fracture: a predictor of bowel injury in children.
Pediatr Radiol.
2002;
32
892-895
- 22
Santucci R A, Langenburg S E, Zachareas M J.
Traumatic hematuria in children can be evaluated as in adults.
J Urol.
2004;
171
822-825
- 23
Strouse P J. et al .
CT of bowel and mesenteric trauma in children.
Radiographics.
1999;
19
1237-1250
- 24
Sivit C J, Taylor G A, Bulas D I. et al .
Posttraumatic shock in children: CT findings associated with hemodynamic instability.
Radiology.
1992;
182
723-726
- 25
Sivit C J. et al .
CT in children with rupture of the bowel caused by blunt trauma: diagnostic
efficacy and comparison with hypoperfusion complex.
Am J Roentgenol.
1994;
163
1195-1198
- 26
O'Hara S M. et al .
Intense contrast enhancement of the adrenal glands: another abdominal CT finding
associated with hypoperfusion complex in children.
Am J Roentgenol.
1999;
173
995-997
Dr. med. Minette von Wickede
Zentrum der Radiologie
Institut für Diagnostische und Interventionelle Radiologie
Abteilung für pädiatrische Radiologie
Theodor-Stern-Kai 7
60590 Frankfurt am Main
Phone: +49 69 6301-5248
Fax: +49 69 6301-83785
Email: Minette1@gmx.de