Free fluid on abdominal computed tomography scan after blunt trauma does not mandate exploratory laparotomy in children

Background/Purpose: The isolated finding of free intraperitoneal fluid on a bdominal computed tomography (CT) scan after blunt trauma in adults is cons idered an indication for laparotomy by many trauma surgeons. The authors wi shed to determine if these guidelines are applicable to children. Methods: A retrospective chart review was conducted. The authors included a ll children (less than or equal to 12 years of age) sustaining blunt abdomi nal trauma who were admitted to our institution between January 1, 1994 and November 1, 1998. Results: There were 814 children admitted, and 437 had abdominal CT scans. Thirty-four studies showed free fluid associated with solid organ injuries, spine or pelvic fractures, or pneumoperitoneum, and were excluded. Thirty- two children had free fluid without associated injuries and formed the basi s for the study. Five of these children underwent laparotomy based on the C T finding alone. The remaining 27 were observed with serial abdominal exami nations and did not require surgical intervention. Only 1 of the 5 children who underwent surgery for the finding of isolated free fluid had a therape utic laparotomy. in comparison, during the same period, 38 children underwe nt laparotomy after blunt injury based only on physical examination finding s with a therapeutic laparotomy rate of 68%. The therapeutic laparotomy rat e was significantly higher when the procedure was based solely on clinical examination as compared with the isolated finding or free fluid on the abdo minal CT (26 of 38 v 1 of 5, P < .05). Conclusion: in contrast to adults, finding isolated free fluid on abdominal CT scans in children after blunt trauma does not dictate immediate surgica l exploration. Copyright (C) 2000 by W.B. Saunders Company.