THE USE OF LAPAROSCOPY IN THE MANAGEMENT OF SEAT-BELT TRAUMA IN CHILDREN

Abdominal wall, hollow viscous, and spinal cord injuries are severe co mplications of two-point seat belt restraints in children. Somatic abd ominal wall pain can mask the presence of potentially life-threatening intraperitoneal injuries, false-positive peritoneal lavage can lead t o unnecessary celiotomy, and CT scan can miss hollow viscous injury. A ll of these concerns point to the need for a more effective diagnostic modality. Laparoscopy may have a role in the diagnosis and management of lap belt-related hollow viscous and mesenteric injuries. The prese nce of either free peritoneal fluid or mesenteric thickening, seen on CT scan, associated with an seat belt-related abdominal wall contusion are criteria for diagnostic laparoscopy. Four patients, age 3 to 15, underwent laparoscopy. Diagnostic laparoscopy employed two additional laterally placed ports and extreme Trendelenburg and reverse Trendelen burg to facilitate the thorough examination of the small bowel. Injuri es identified were a severely contused cecum, a contusion of the small bowel with associated mesenteric hematoma, transverse colon contusion and gastric perforation, and a small bowel contusion. No delayed reex plorations were required for missed injuries and there were no complic ations associated with laparoscopy. This experience suggests that lapa roscopy may have a role in the diagnosis and management of seat belt t rauma in children.