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Trauma nowadays accounts for one of the most important causes of childhood mortality. According to a world report by the WHO and UNICEF (United Nations International Children’s Emergency Fund) in 2008, every single day, more than 2000 children die because of accidents. Although fractures of limbs and head and neck injuries are most common, around 10% of trauma deaths in childhood are due to abdominal injuries [1–3]. The abdomen can be afflicted in penetrating or blunt manner. There is difference in this data with respect to developed and developing country [3]. Injury pattern in children is governed by age, gender, ethnicity, and socioeconomic status. In children more than 1 year of age, approximately 50% of deaths are due to trauma [1].

Trauma involving the abdomen is the most common cause of death in children due to unrecognized injury. In pediatric emergency a significant portion of workloads on pediatric surgeon to assess the injured child with a focus on abdominal trauma. Pediatric trauma differs from adult trauma in many ways, e.g., mechanisms, injury patterns, anatomy, and long-term effects on growth and development. A focused clinical examination diagnoses most of the important injuries and avoids unnecessary management delays and investigations. Diagnosing intra-abdominal injury is the crux of the examination. Intra-abdominal organs can be injured either by blunt or penetrating injuries. Blunt injuries are much more common than penetrating injuries (85% vs 15%). Pediatric internal organs are more likely to be injured owing to a smaller torso, larger and more mobile viscera, and decreased amount of intra-abdominal fat [1, 2].

Intestinal injury is less commonly seen than solid organ injury in blunt abdominal trauma. There is 1–15% reported incidence of intestinal injury in children with blunt trauma. Since its incidence is not so common, a high index of suspicion is required for its diagnosis and better prognosis. The jejunum is the most common site of intestinal injury, particularly near the ligament of Treitz followed by the ileum, duodenum, colon, and stomach in that order.

It is reported that the incidence of solid organ injuries in children with blunt abdominal trauma varies from 4% to 8% depending on the site of injury and the mode of impact. Most cases of solid organ injuries in children are minor grade, with only few injuries involving major parenchymal or vascular disruptions. The optimal management of pediatric patients with solid organ injury has shifted toward nonoperative management. But the management of high-grade injuries remains poorly defined and relies heavily on associated factors. This paradigm shift in treatment protocol of solid organ injury has many advantages. It means reducing the hospital stay and cost and less operative and postoperative complications for patients. It also means management “at home” or with the primary care pediatrician, thereby allowing intensivist and pediatric surgeon to allocate ample amount of time to more critical cases. Since children are usually healthy, with not many comorbid conditions and hardly on any medications, they are able to withstand the hemodynamic instability much better than adults [1].

Traumatic injury, intentional or unintentional, is the main cause of deaths in children and adolescents than all other causes put together. Blunt form of trauma is a more common injury in children. The penetrating type of trauma constitutes 10–20% of all admissions in children with the increase in violence among 13–18-year-olds. It must be stressed that the pediatric patient is different physiologically from an adult counterpart but the basic principles remain the same [1].