Traumatismes abdominaux chez l’enfant : aspects épidémiologiques, diagnostiques et thérapeutiques. Étude rétro prospective sur 5 ans à l’Hôpital Mixte de Laghouat. Laghouat.

Abstract

Introduction: Pediatric abdominal trauma represents a frequent and complex medico-surgical problem, exacerbated by pediatric anatomical and physiological peculiarities. This retrospective study aimed to describe the epidemiological, clinical, paraclinical, and therapeutic characteristics of abdominal trauma in children, as well as their evolution, at the Laghouat Mixed Hospital over a five-year period (2021-2025). Materials and Methods: This work is based on the analysis of two series of pediatric patients. The first population (the emergency department population), comprising 903 cases, was studied to determine the role and cost-effectiveness of CT scans in the initial assessment. The second hospitalized population, consisting of 34 cases of abdominal trauma requiring hospitalization, was subjected to an in-depth analysis of their epidemiological, clinical, paraclinical, and therapeutic aspects. Results: Analysis of cases admitted to the emergency department revealed an overuse of CT scans in the initial assessment. Thirty-four cases of children hospitalized for abdominal trauma, representing 3.86% of pediatric visceral surgical emergencies. A marked male predominance (79.41%) with an average age of 7.38 years. Road traffic accidents (RTAs) constituted the main etiological circumstance (55.88%). Clinically, 82.35% of patients were hemodynamically stable on admission. Imaging played a pivotal role: ultrasound was performed in 85.29% of cases, while computed tomography (CT), the reference examination for lesion staging, was performed in 73.52% of patients. The use of MRI remained exceptional at 2.94% of cases. The liver was the most frequently injured organ (44.11%), followed by the spleen (29.41%). Non-operative management was favored with a remarkable success rate of 85.29%. Surgical treatment (14.7%) was reserved for cases of persistent instability or perforation of hollow organs and failure of NOM. While the treatment success rate was 94%, secondary recourse to surgery in cases of NOM failure or complication allowed for a favorable outcome in all patients, thus bringing the overall therapeutic success rate to 100%. Conclusion: Our study at Laghouat mixed hospital validates the primacy of non-operative management in pediatric abdominal trauma, achieving a 100% therapeutic success rate through a rigorous surveillance strategy and selective surgical intervention. Diagnostic accuracy is ensured by radio-biological coupling, highlighting the need to establish a rigorous decision-making algorithm to guide the indication for CT scans, in order to limit unnecessary radiation exposure in children without compromising diagnostic precision. Concurrently, the epidemiological profile dominated by (boys, public road accidents) underscores the importance of targeted prevention policies adapted to the local socio-economic context.