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188 Abdominal Trauma

SUSPECTED
ANORECTAL INJURY

EXAMINATION UNDER
ANAESTHESIA +
PROCTOSIGMOIDOSCOPY

INJURY IDENTIFIED UNABLE TO
AND GRADED ASCERTAIN
INTRAPERITONEAL
RECTAL INJURY (but
high degree of
suspicion)

I II III IV V Plain abdominal x-ray ±
contrast enema
Primary Primary Colostomy ± Laparotomy Laparotomy
repair repair ± primary repair colostomy repair IR
colostomy if accessible repair IR injury
± drainage injury treat other
repair ER injuries Air/contrast Negative
injury if in peritoneal
accessible cavity

IV V Observe

Laparotomy

Figure 29.5: Treatment of anorectal injuries (IR: intraperitoneal rectum; ER: extraperitoneal rectum).

Table 29.1: Evidence-based research.
Title Paediatric blunt abdominal trauma: challenges of manage-
ment in a developing country
Authors Chirdan LB, Uba AF, Yiltok SJ, Ramyil VM
Institution Jos University Teaching Hospital, Jos, Nigeria
Reference Eur J Pediatr Surg 2007; 17:90–95
Problem To determine whether a simple protocol with ultrasonography
significantly reduced the rate of laparotomy in countries with
limited facilities.
Intervention Retrospective review.
Comparison/ Laparotomy rates were compared between two groups, with
control and without a management protocol that included abdominal
(quality of ultrasound (US) and plain abdominal films.
evidence)
Outcome/ Laparotomy rates were lower in the group in which the man-
effect agement protocol was followed.
Historical Paediatric abdominal trauma in resource-poor settings can
significance/ be successfully managed by using a simple protocol that de-
comments pends on careful clinical assessment and simple radiologic
tests.