An audit of trauma laparotomy in children and adolescents highlights the role of damage control surgery and the need for a trauma systems approach to injury in this vulnerable population

Keywords: trauma laparotomy, children, adolescents, damage control surgery, trauma systems approach, vulnerable population

Abstract

Background: This study reviews the indications and outcome of emergency laparotomy for paediatric trauma in a South African trauma centre.

Methods: This was a retrospective study of all children less than 18 years of age who underwent an emergency laparotomy for trauma between December 2012 and October 2020 at Grey’s Hospital in Pietermaritzburg.

Results: During the eight-year period under review, a total of 136 children of which 107 were male underwent a laparotomy for trauma. The median age was 14 years. There were 80 (57.1%) blunt mechanisms, and the rest were penetrating mechanisms. A total of 46 (33%) patients required ICU admission. Thirty-four patients developed a complication. These included nine cases of pneumonia, one case of renal failure, two patients developed abdominal collections, three woundrelated complications, three neurological complications and one miscellaneous complication. There were seven (5%) deaths. The penetrating cohort were older than the blunt cohort. Solid viscera were more likely to be injured in the blunt cohort and hollow viscera more likely in the penetrating cohort. A total of 16 (11%) patients underwent damage control surgery (DCS). Of this cohort, there were three female children. Six sustained blunt trauma and ten penetrating trauma. A total of six (37%) of these children died.

Conclusion: Emergency laparotomy for trauma in children is not infrequent in Pietermaritzburg and there is a high incidence of penetrating trauma in this cohort. The response to increased degrees of physiological derangement is the application of DCS. Ongoing efforts to develop and strengthen a paediatric trauma service appear to be justified.

Author Biographies

B Reid, University of Auckland

Department of Surgery, University of Auckland, New Zealand

V Kong, Auckland City Hospital

Department of Surgery, Auckland City Hospital, New Zealand, and Department of Surgery, University of the Witwatersrand and Department of Surgery, University of KwaZulu-Natal, South Africa

W Xu, University of Auckland

Department of Surgery, University of Auckland, New Zealand

V Thirayan, Waikato Hospital

Department of Surgery, Waikato Hospital, New Zealand

C Cheung, Chris Hani Baragwanath Academic Hospital

Department of Surgery, Chris Hani Baragwanath Academic Hospital, South Africa

N Rajaretnam, St James's Hospital

Department of Surgery, St James's Hospital, Ireland

V Manchev, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu-Natal, South Africa

W Bekker, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu-Natal, South Africa

J L Bruce, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu-Natal, South Africav

G Laing, University of KwaZulu-Natal

Department of Surgery, University of KwaZulu-Natal, Durban, South Africa

D L Clarke, University of the Witwatersrand

Department of Surgery, University of the Witwatersrand and Department of Surgery, University of KwaZulu-Natal, South Africa

Published
2022-06-28
How to Cite
Reid, B., Kong, V., Xu, W., Thirayan, V., Cheung, C., Rajaretnam, N., Manchev, V., Bekker, W., Bruce, J., Laing, G., & Clarke, D. (2022). An audit of trauma laparotomy in children and adolescents highlights the role of damage control surgery and the need for a trauma systems approach to injury in this vulnerable population. South African Journal of Surgery, 60(2), 97-102. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3732
Section
Trauma