The use of laparoscopy in the management of seat belt trauma in children.

Abdominal wall, hollow viscous, and spinal cord injuries are severe complications of two point seat belt restraints in children. Somatic abdominal wall pain can mask the presence of potentially life-threatening intraperitoneal injuries, false-positive peritoneal lavage can lead to unnecessary celiotomy, and CT scan can miss hollow viscous injury. All of these concerns point to the need for a more effective diagnostic modality. Laparoscopy may have a role in the diagnosis and management of lap belt-related hollow viscous and mesenteric injuries. The presence of either free peritoneal fluid or mesenteric thickening, seen on CT scan, associated with an seat belt-related abdominal wall contusion are criteria for diagnostic laparoscopy. Four patients, age 3 to 15, underwent laparoscopy. Diagnostic laparoscopy employed two additional laterally placed ports and extreme Trendelenburg and reverse Trendelenburg to facilitate the thorough examination of the small bowel. Injuries identified were a severely contused cecum, a contusion of the small bowel with associated mesenteric hematoma, transverse colon contusion and gastric perforation, and a small bowel contusion. No delayed reexplorations were required for missed injuries and there were no complications associated with laparoscopy. This experience suggests that laparoscopy may have a role in the diagnosis and management of seat belt trauma in children.