Board MCQ Bank

Management of colorectal injuries has evolved significantly. According to current pediatric surgical data, in hemodynamically stable patients with rectal injuries below the peritoneal reflection that involve less than 50% of the bowel circumference, primary repair (often transanal) can be safely performed without fecal diversion.

The physical examination finding of abdominal wall bruising (seat belt sign) is significant, with up to 19% of these children having an intra-abdominal injury, and 11% having a bowel injury. It warrants serial abdominal examinations regardless of the decision to image.

Risk factors for failure of NOM include an associated pancreatic injury, combined liver/spleen injuries, early transfusion, and contrast extravasation. Gender, age, and liver vs. spleen injury do not increase risk. A fall mechanism is actually associated with a lower risk of failure than other mechanisms.

Traumatic pseudoaneurysm of the main renal artery is an uncommon complication of high-grade blunt renal trauma that can present with hematuria, hypertension, or abdominal pain. According to the guidelines, angiography with embolization of the pseudoaneurysm is the first-line therapy. Surgery (such as an emergency laparotomy or nephrectomy) is generally reserved for patients who are hemodynamically unstable from a rupture or if angioembolization is unsuccessful. Cystoscopic placement of a ureteral stent and percutaneous drainage are the recommended treatments for a symptomatic urinoma (a collecting system injury), not for a vascular pseudoaneurysm.

In a recent retrospective study, an aspartate aminotransferase/alanine aminotransferase (AST/ALT) threshold of <400/<200 had a negative predictive value of 96% in predicting the presence of grade III or higher liver injuries.