- Usually blunt trauma
- Generally follow same principles as adult trauma
- Consider non accidental injury especially in isolated genital injuries
Renal trauma:
- Kidneys probably more susceptible in kids – less perinephric fat, less developed rib cage, diaphragm is flatter so kidneys sit lower and occupy more retroperitoneal space
- Abnormal kidneys probably at higher risk and from lesser trauma – PCKD, PUJO, horseshoe, pelvic kidneys, solitary hypertrophied kidneys
- Wilms tumours may come to light from minor trauma causing a bleed
- Children can lose significant amounts of blood before showing signs of hypovolaemia
- Often concomitant with other visceral injury
- Usually will have at least microscopic if not visible haematuria
- CT is preferred imaging
- Blood pressure needs following
Should kids with one kidney play contact sport?
- Sports associated with renal injury have a 5 x risk of head injury
- Most children are not stopped from playing sports because they only have one head
- Data suggests cycling and motor vehicle accidents are much more likely to cause renal injury
Bladder trauma:
- Intraperitoneal injuries may be more common in children – bladder is above the pelvic brim with less fat and less developed abdominal muscles
- Extraperitoneal injuries generally associated with pelvic fracture
- Pelvic fractures require higher energy injuries cf. adults and so risk of bladder/urethral injury is higher in kids
- All patients with pelvic fractures should be assessed for urinary retention or haematuria
Urethral trauma
- All patients with straddle injuries or pelvic fractures and any hint of urethral blood or retention should have urethrogram
- If complete disruption of urethra -> place SPC and delayed reconstruction
- If able to place urethral catheter -> leave for 2-3 weeks +/- pericatheter urethrogram, and close follow up for potential stricture
Genital injuries:
- Consider non accidental injury
- Penile injury can occur from circumcision, zippers, hair tourniquets, animal bites, and burns
- Manage testicular ruptures as per adults, generally with exploration, debridement and repair with PDS
Animal bites or other traumatic lacerations should be copiously washed out and debrided with strong consideration for delayed closure or healing by secondary intention