This study evaluates the safety and role of laparoscopy in the diagnos
is of blunt abdominal trauma in children. Laparoscopy was performed in
five patients aged 3 to 13 years because of persistent abdominal pain
after blunt trauma. A laparotomy was not indicated from the physical
examination, laboratory data, or radiologic findings. With the patient
under general anesthesia, a 10-mm trocar was inserted through the umb
ilical fossa and the intra-abdominal organs were observed for 10-60 mi
n under an insufflation pressure of 10-12 mmHg. The patients remained
hemodynamically stable without pneumothorax development. Three patient
s underwent laparatomies: one, who had blood in the omental sac, had a
duodenal injury with hemorrhagic necrosis and underwent a resection;
one with ascites and high amylase levels had an injury of the main pan
creatic duct and underwent resection of the pancreatic tail; and one w
ho had fresh blood in the upper abdomen and Douglas' pouch had a splen
ic hemorrhage and underwent hemostasis. The other two had serous or se
rosanguinous ascites and recovered without surgery. In patient 1, the
same amount of information might have been obtained from a barium stud
y. In patient 2, the pancreatic transection might have been diagnosed
from ascites shown on serial computed tomograms. Patient 3 might also
have been treated successfully non-surgically. It hus appears that lap
aroscopy may be a safe diagnostic method for blunt abdominal trauma in
children, however, this small series has yielded insufficient informa
tion to assess its usefulness in making the diagnosis and the decision
for laparotomy. Further studies are required to ascertain whether it
will make any significant difference in the form of management.