Blunt Intestinal Injury in Children

Abstract

The initial physical examination findings and CT evaluation can independently identify the presence of intestinal injury in approximately 25% of cases. In the remainder of cases, the awareness of the more subtle findings of bowel injury on a CT scan can complement the physical examination findings and potentially lead to a more timely intervention for bowel injury.

Choledochoduodenal fistula caused by blunt abdominal trauma in a child

“…Only 2% to 10% of the serious blunt abdominal trauma results in duodenal injury in children, and the diagnoses can be challenging [9,10]. Duodenal injuries can be associated with intramural hematoma, perforation, and associated pancreatic injury.…”

Small bowel injuries in children

“… 16 Our data indicate that delay can be associated with significant morbidity and even mortality when significant peritoneal contamination has occurred by the time the diagnosis has been made. 3,4,7,8 This may be a problem particularly in preschool children in whom the greater omentum is relatively poorly developed: in this group delayed diagnosis of a SBI may lead rapidly to peritonitis, general sepsis and death.…”

“…1,2 Although blunt abdominal trauma is common in childhood, small bowel injury (SBI) is infrequent with an incidence of between 1 and 7% in most series. 3–10 However, there is evidence that the incidence of this injury is increasing, perhaps as a result of legislative changes requiring the use of passenger restraints and the design of the lap‐only belt. 11–13 The presentation of SBI may be delayed and the initial physical findings deceptive.…”

“… 11–13 The presentation of SBI may be delayed and the initial physical findings deceptive. 5,8–10 Despite radiological imaging including ultrasound (US) or computed tomography (CT) scan with contrast, the diagnosis is often not made until peritonitis occurs. 4,6–10 The significance of this diagnostic delay in children is uncertain, with most series reporting few adverse sequelae and no deaths.…”

Editorial

“…Delay in final diagnosis is noted in 75% of the cases, especially in multiple trauma where depressed consciousness precludes relevant physical examination. Surprisingly, the rate of related complications remains low even with a delay in treatment exceeding 48 h ( 30, 31). Signs of persistent peritoneal irritation could be the last indication for peritoneal lavage which may be the more sensitive diagnostic modality ( 32), even though most of the lesions could have been diagnosed earlier provided that a high level of suspicion and meticulous interpretation of the CT scan had been used.…”