Thorakale und abdominale Organverletzungen bei Kindern und Jugendlichen

Zusammenfassung

Thorakale und abdominale Organverletzungen sind im Kindes- und Jugendalter selten. Thorakal stehen Lungenkontusionen ganz im Vordergrund. Rippenfrakturen treten aufgrund der Elastizität der Rippen seltener auf. Wird eine Beatmung erforderlich, gilt der Fokus der Vermeidung einer zu frühen Extubation, um ein Rebound-Phänomen mit erheblicher Verschlechterung der Gesamtsituation zu verhindern. Bei den Bauchtraumen kommen Milz-, Leber- und Nierenverletzungen am häufigsten vor. Auf der Basis eines verlässlichen CT-Gradings erfolgt die Therapie meist konservativ unter Kreislauf-Monitoring. Interventionelle Verfahren können im Einzelfall hilfreich sein (Stent, Drainage). Die Laparotomie erfolgt, wenn mehr als 40 ml Blutprodukte/kg Körpergewicht und Tag substituiert werden müssen. Für den Verlauf gibt es ein evidenzbasiertes Protokoll.

Abstract

Thoracic and abdominal organ injuries are rare in children and adolescents. In thoracic trauma pulmonary contusions are in the foreground. Rib fractures are infrequent because of the higher elasticity of the thoracic cage. If ventilation is necessary, one have to avoid early extubation to prevent a rebound with important deterioration of the general condition. In abdominal trauma spleen, liver and kidney injuries are most common. Based on CT grading conservative treatment with monitoring of circulation is the management of first choice. Interventional procedures may be helpful (stent, drainage). Laparotomy is necessary if more than 40 ml blood substitution per kg bodyweight per day is needed for stable circulation. For the follow-up an evident protocol exists.

Schlüsselwörter

Thoraxtrauma - Bauchtrauma - Kindesalter

Key words

thoracic trauma - abdominal trauma - children

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