Zeng Xinhao,Zhang Xindan,Liu Ming.Value of non-operative measures for children duodenal intramural hematoma due to blunt abdominal trauma with gastrointestinal obstruction[J].Journal of Clinical Pediatric Surgery,,20():49-55.[doi:10.12260/lcxewkzz.2021.01.010]
Value of non-operative measures for children duodenal intramural hematoma due to blunt abdominal trauma with gastrointestinal obstruction
- Keywords:
- Trauma; Duodenum/IN; Hematoma/TH; Intestinal Obstruction/TH; Treatment Outcome; Child
- CLC:
- R574.51;R574.2
- Abstract:
- Objective To explore the therapeutic efficacy and significance of non-operative measures for duodenal intramural hematoma due to blunt abdominal trauma with gastrointestinal obstruction.Methods The clinical and imaging data were retrospectively analyzed for 8 children diagnosed as duodenal intramural hematoma due to blunt abdominal trauma with gastrointestinal obstruction over the last 3 years.There were 5 boys and 3 girls with an average age of 9.1(5-16) years.All children suffered blunt abdominal trauma.Their clinical symptoms were nausea,vomiting and abdominal pain.The scans of computed tomography (CT) hinted at duodenal hematoma with gastrointestinal obstruction without gastrointestinal perforation and active bleeding.Treatment options included fasting,continuous gastro-intestinal decompression while recording color and amount of drainage fluid,prophylactic antibiotics,total parenteral nutrition (TPN),somatostatin for abnormal amylase and regular monitoring of blood routine,biochemical profiles and electrolytes for maintaining homeostasis.The relevant reports were retrieved from the databases of Wanfang,CQVIP,CNKI,PubMed and MedLine prior to February 2020.Results Seven cases were cured non-operatively.Oral feeding was resumed at an average posttraumatic time of 15.2(8-26) days.The amount of gastrointestinal decompression peaked at 3-5 days after injury and began to drop at 4-18 days.There were the elavations of aminopherase and bilirubin after 10 days with TPN in some children and decreased after hepatoprotective therapy and oral feeding.After a follow-up period of 6 months to 3 years,there was no occurrence of any complication.The symptoms of one child were not relieved after 3 weeks of conservative measures (including 1 week at another hospital).CT reexamination indicated no change in hematoma size.Finally the child recovered after surgery.During a follow-up period of 2 years,there was hospitalization for adhesive ileus and the child recovered after conservative measures.A total of 339 children with traumatic duodenal hematoma were retrieved from 31 literature reports,including 8 cases in our cohort.Among them,189 cases were operated (1-30 days after injury) and 150 cases received conservative treatment (7-29 days).Conclusion Conservation treatment should be a first choice for duodenal hematoma without active bleeding or perforation and vital signs remain stable after antishock and hemostasis,etc.The variations of volume and color of gastrointestinal decompression may guide the outcomes and treatments of diseases.The duration of conservation treatment should be extended to 3 weeks or longer if volume of gastrointestinal drainage becomes less and color weaker.Surgery should be performed if there is no symptomatic relief after conservative treatmen for over 3 weeks.Operation is simple with an excellent outcome since hematoma has liquefied.Open surgery or percutaneous drainage is desired.
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Memo
收稿日期:2020-04-28。
基金项目:四川省出生缺陷临床医学研究中心基金资助项目（编号：2019YFS0531-8）
通讯作者:刘铭,Email:liuming6603@163.com