Abstract

Aim: Children may have important pathologies which are not identified but will influence the mortality and morbidity of the traumatic event. In this report we aim to emphasize the importance of a thorough physical examination, and evaluation of all of the findings, even those which seem not to be related with the event in blunt trauma patients.

Materials and Methods: We retrospectively reviewed the trauma patients admitted to our emergency department between January 1995-October 2007. Of these, 107 patients (64 male, 43 female) age ranging between 2-14 years (mean 7,2 years) had other associated findings not directly related with the trauma. Further investigations plain abdominal x-ray, included ultrasonography (USG), computerized tomography (CT), intravenous urography (IVU), magnetic resonance urography (MRU) and scintigraphy.

Results: The etiology of the blunt trauma in patients with associated findings was traffic accident in 51, falls in the other 56 patients. Neither the patient nor the parents had informed about the coincidental finding in the history. The additional findings were grouped into urinary system findings (n:73) and other pathologies (n:34). Additional findings were identified on physical examination, or with interpretation of results of tests made on routine basis in blunt trauma patients like urine analysis, plain abdominal x-ray, or abdominal USG, which lead us to further evaluate the patient. In the other group, abdominal mass was detected on routine physical examination in 5 patients (4 on the right, 1 on the left side). During the surgery of these patients 2 adrenal and 3 renal masses were completeley resected; the histopathologic examination of the renal masses was reported as Wilms tunor; and of the adrenal masses as neuroblastoma and ganglioneuroblastoma. Ten patients who developed rashes after blunt surgery, were diagnosed as perforated hydatic cysts and cystectomy was performed. Of the patients who had posttraumatic generalized abdominal pain, ovarian cyst rupture was diagnosed in 5 and ovarian cyst torsion in 3 of the patients. Four of the other cases with ovarian cysts were operated and the other two who had smaller cysts were followed up. Five patients with hiatal hernia were operated. One patient which was operated for Wilms tumor and thrombectomy of the inferior vena cava died during postopertive period. All the other patients are still on follow-up.

Conclusion: Trauma patients should always be considered to have additional problems that even the patients and the parents are not aware of. We propose that in all trauma patients, a thorough physical examination should be made and the findings together with the laboratory and radiologic studies should be evaluated for the definite problem. This will help us to identify life threatening pathologies and thus leading to a decrease in mortality and morbidity.