Isolated free fluid in children with blunt abdominal trauma: Does it alters the management approach?

Introduction. Isolated free fluid (IFF) on abdominal computed tomography in children with blunt abdominal trauma poses a diagnostic dilemma. The aim of this study is to present our experience of the entity and its role in management of these children. Methods. A prospective study was performed over a period of two and half years on all the children less than 14 years of age admitted to our hospital with blunt abdominal trauma and in whom the CT abdomen was done which demonstrated isolated free fluid with no sign of visceral injury. Demographic data, presenting clinical status, imaging data and management (nonoperative progress and operative findings) were collected and analyzed. Results. A total of 108 children were admitted with blunt abdominal trauma and who underwent abdominal CT during the period from July 2015 to December 2017. Isolated free fluid (IFF) was found in 26 children (24%). The mean age was 7.8 years with male predominance. Motor vehicle collisions were the most common mechanism of injury. At presentation abdominal tenderness was present in 8 of these children. Twenty two children had small IFF and 2 each had moderate and large fluid collections and the most common site being the hepatorenal pouch. One child each from moderate and large IFF group needed subsequent exploration. Conclusion. Children of blunt abdominal trauma with isolated free fluid on abdominal CT are managed conservatively. However, they need admission and repeated clinical assessment for early detection of delayed presentation of visceral injury entailing surgical intervention.