Blunt Polytrauma in Two Pediatric Patients: Surgical vs. Conservative Management – A Two-Case Study

Abstract

Background: Pediatric blunt abdominal trauma presents complex diagnostic and therapeutic challenges. This case series highlights two pediatric patients with polytrauma from road traffic accidents, each with distinct intra-abdominal injuries and differing management strategies.

Case Presentation: Case 1 involved a 7-year-old female with pulmonary contusion, facial lacerations, splenic rupture, and bowel perforation. Case 2 involved a 13-year-old female presenting with macrohematuria and left flank pain after ejection from a vehicle; imaging revealed a Grade III/IV renal laceration with retroperitoneal hematoma and minor pleural effusion.

Intervention: Case 1 underwent emergency laparotomy with splenectomy and segmental bowel resection, followed by intensive monitoring and antimicrobial therapy. Case 2 was managed conservatively with intravenous fluids, antibiotics, and blood transfusion.

Outcome: Both patients recovered without major complications. Case 1 had a shorter hospital stay following definitive surgical control. Case 2 required prolonged observation due to the risk of delayed renal complications but achieved complete recovery.

Conclusions: Hemodynamically unstable patients with splenic rupture and bowel perforation require urgent surgery, while stable patients with high-grade renal injuries can be managed non-operatively, emphasizing individualized, stability-based care.