Nonoperative management of blunt abdominal trauma in pediatrics.

The management of blunt abdominal trauma in children has undergone significant modification in the past decade because of advances in diagnostic imaging and an improved understanding of the natural history of injury to the spleen and liver. Mandatory laparotomy for proven or suspected hemoperitoneum has been replaced by intensive observation of most patients who are stable or who can be stabilized in the Emergency Department. The result has been a significant reduction in morbidity owing to anesthetic complications, postsplenectomy sepsis, and peritoneal adhesions. To take full advantage of these advances, emergency physicians and other primary care providers should be aware of the often subtle manifestations of abdominal trauma, the available diagnostic modalities and their limitations, and the requirements for volume resuscitation in pediatric patients.