ECMO-/ECLS

physical exam findings (such as bruising, distention, or tenderness), may
indicate the need for further abdominal imaging looking for occult injury [11].
Computed tomography (CT) is the preferred diagnostic modality for
children with a potential abdominal injury. A CT scan with intravenous contrast
is the most sensitive and specific imaging modality with regard to evaluating the
abdomen and retroperitoneum. In fact, CT scan is very sensitive and has led
some to suggest that a negative CT scan after blunt abdominal trauma may
obviate the need for in-patient observation [2].^ A child with hemodynamic
instability should not be sent for CT evaluation.
CT scan is limited in evaluating acute diaphragmatic, mesenteric,
intestinal injuries. A typical diagnostic uncertainly in a trauma patient is the
presence of free fluid without solid organ injury. Fluid in the abdomen may be a
normal finding or may suggest bowel injury or may be an incidental finding. In
these circumstances, laparoscopy may be utilized common diagnostic adjunct,
depending on the clinical scenario. In two relatively large reviews, laparoscopy
was found to be safe; by avoiding laparotomy, length of hospital stay is
potentially shortened in patients undergoing laparoscopy [8-9]. A number of
injuries can be approached using laparoscopic techniques. CT and
laparoscopy may provide complementary information: CT evaluates areas that
are cumbersome to access laparoscopically such as the retroperitoneum,
kidneys, and pancreas, while laparoscopy allows for direct visualization of the
regions not well assessed by CT such as bowel, mesentery, and diaphragm
surfaces.