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Oral contrast with computed tomography in the evaluation of blunt abdominal trauma in children
K R Shankar1, D A Lloyd, L Kitteringham
1Department of Paediatric Surgery, Paediatric Radiology, Alder Hey Children's Hospital, Liverpool, UK.
Insights
Oral contrast does not improve computed tomography (CT) accuracy for diagnosing intestinal injuries in children with blunt trauma. Omitting oral contrast did not delay diagnosis, suggesting it may not be necessary for pediatric abdominal CT scans.
Area of Science:
- Pediatric Radiology
- Abdominal Trauma Imaging
- Gastrointestinal Tract Evaluation
Background:
- The utility of oral contrast agents in computed tomography (CT) for evaluating blunt abdominal trauma in children remains a subject of debate.
- This retrospective study aimed to assess the effectiveness of oral contrast in conjunction with abdominal CT for diagnosing suspected abdominal injuries in pediatric patients.
Purpose of the Study:
- To retrospectively evaluate the diagnostic performance of oral contrast-enhanced abdominal CT in children with suspected blunt abdominal trauma.
- To determine if oral contrast improves the detection of intestinal injuries compared to CT without oral contrast.
Main Methods:
- Reviewed medical records of 101 children who underwent CT for abdominal trauma (1993-1997).
- Assessed injury mechanism, clinical findings, and management.
- Paediatric radiologist reviewed CT scans using established criteria for intestinal injury (extraluminal air/contrast, bowel wall thickening, free fluid).
Main Results:
- Oral contrast failed to opacify the duodenum in 62% of scans.
- CT correctly identified intestinal injury in only two children (one duodenojejunal rupture, one ileal perforation).
- False-positive and false-negative CT findings occurred with and without oral contrast, leading to unnecessary or delayed laparotomies.
Conclusions:
- Computed tomography (CT) demonstrates limited reliability in diagnosing pediatric intestinal injuries, and oral contrast does not enhance its accuracy.
- The omission of oral contrast did not correlate with delayed diagnosis of intestinal injuries.
- Further prospective multicentre studies are warranted to clarify the role of routine oral contrast in pediatric abdominal CT for trauma.
Background:
The use of oral contrast in evaluating children by computed tomography (CT) following blunt trauma is controversial. The aim of this study was to evaluate retrospectively the use of oral contrast with abdominal CT in children with suspected abdominal injury.
Methods:
The medical records of 101 children who underwent CT for abdominal trauma between 1993 and 1997 were reviewed for data pertaining to the mechanism of injury, clinical findings and management. Scans were reviewed by a paediatric radiologist and criteria of intestinal injury on CT described by Cox and Kuhn were used: (1) extraluminal air or contrast material, (2) focal area of thickening of bowel wall and mesentery, and (3) free intraperitoneal fluid in the absence of solid organ injury.
Results:
CT was performed within a median time of 2.4 (range 1-48) h after the injury. On 37 (62 per cent) of 60 scans in children who had oral contrast, the duodenum was not opacified after a mean delay of 30 min. Intestinal injury was suspected on CT in four children. In two children with CT evidence of intestinal injury (with/without oral contrast) rupture of the duodenojejunal flexure (n = 1) or ileal perforation (n = 1) was found at laparotomy. Two children had a false-positive scan, leading to negative laparotomy; one scan with oral contrast incorrectly suggested a duodenal leak and in another child CT without oral contrast showed thickening of bowel wall with free intraperitoneal fluid but no specific intestinal injury was identified at laparotomy. One patient had two negative CT scans (with and without oral contrast) and underwent laparotomy for clinical suspicion of bowel injury; rupture of the splenic flexure of the colon was found at laparotomy.
Conclusion:
CT is not reliable for diagnosing intestinal injuries and this is not improved by use of oral contrast. Omission of oral contrast was not associated with delay in the diagnosis of intestinal injury. Since intestinal injuries are uncommon in children, a prospective multicentre study would determine more precisely the role of the routine use of oral contrast.
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