Small bowel injuries in children

Abstract

Persistent tachycardia with an appropriate mechanism of injury following blunt abdominal trauma requires active exclusion of SBI. Delayed diagnosis is associated with significant morbidity and mortality.

Small bowel perforation and fatal peritonitis following a fall in a 21-month-old child

“…Although small bowel is the third most frequently damaged organ (after liver and spleen) following blunt abdominal trauma, injury is still considered to be ''infrequent,'' occurring in 5-15% of such cases [7,8]. The type of injuries noted include contusions-of the bowel and mesentery-and perforations; the latter have been observed in the duodenum, jejunum, and ileum and are estimated to occur in less than 1% of children with ''significant blunt trauma'' [4,8,14,19].…”

“…The type of injuries noted include contusions-of the bowel and mesentery-and perforations; the latter have been observed in the duodenum, jejunum, and ileum and are estimated to occur in less than 1% of children with ''significant blunt trauma'' [4,8,14,19]. It has been suggested that the risk of bowel perforation is increased in children-compared to adults-because the omentum and abdominal muscles are less well developed [9].…”

“…There was a fairly rapid clinical deterioration and the diagnosis was only established at necropsy, which highlights the difficulty in diagnosing small bowel injury in children [4,8,22] for which several reasons have been suggested: children seem to have a greater ''physiological reserve''; communication of symptoms may be a problem with younger children; physical signs and symptoms may be subtle and/or delayed in onset [10,22,25,26]. In particular, bruising of the abdominal wall is by no means a universal finding, having been reported in 7.7-62% of blunt abdominal trauma cases [1,2,5,27,28].…”

“…less than 5% [2][3][4]. The majority of such cases are due to vehicle-or bicycle-related accidents or assault, therefore, the possibility of physical abuse must be considered [1][2][3][4][5][6][7][8][9]. However, it should be remembered that falls and ''unusual'' incidents occasionally may be responsible [2,6,[9][10][11][12][13].…”

Chance-Type Fracture of L1 with Entrapment of the Cauda Equina

“…The association of thoracolumbar fractures and abdominal injuries after a motor vehicle accident is well documented [10,12,[16][17][18][19][20]. In the presence of Chancetype thoracolumbar flexion-distraction lesion, Anderson et al [12] noticed a life-threatening intraabdominal trauma in 65% of the patients.…”