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CT of bowel and mesenteric trauma in children
P J Strouse1, B J Close, K W Marshall
1Department of Radiology, C.S. Mott Children's Hospital, University of Michigan Health System, Ann Arbor 48109-0252, USA.
Insights
Recognizing subtle computed tomographic (CT) findings is crucial for diagnosing pediatric bowel or mesenteric trauma. Specific CT signs can indicate injuries requiring surgical intervention, differentiating them from non-surgical cases.
Area of Science:
- Pediatric Radiology
- Abdominal Imaging
- Trauma Surgery
Background:
- Most pediatric abdominal trauma is managed non-surgically.
- Gastrointestinal perforation or infarction in children mandates surgical intervention.
- Early identification of bowel or mesenteric trauma is critical.
Purpose of the Study:
- To outline key computed tomographic (CT) findings associated with pediatric bowel or mesenteric trauma.
- To differentiate CT findings indicative of surgical necessity versus those requiring less invasive management.
- To correlate specific CT abnormalities with the likelihood of surgical repair in pediatric trauma patients.
Main Methods:
- Review of computed tomographic (CT) scans in pediatric patients with suspected bowel or mesenteric trauma.
- Analysis of CT findings including free air, fluid, bowel wall abnormalities, and mesenteric changes.
- Correlation of imaging findings with clinical history (e.g., lap belt injury, child abuse) and surgical outcomes.
Main Results:
- Pediatric bowel/mesenteric trauma often presents with multiple CT abnormalities.
- Specific findings like free intraperitoneal air and focal bowel wall thickening strongly suggest surgical repair is needed.
- Less specific findings include free intraperitoneal fluid, mesenteric stranding, and focal hematoma.
Conclusions:
- Computed tomographic (CT) imaging is essential for diagnosing traumatic bowel or mesenteric injuries in children.
- A spectrum of CT findings exists, with some indicating a high probability of surgical intervention.
- Distinguishing traumatic bowel injury from the hypoperfusion complex can be challenging but is clinically important.
Abstract:
Although most traumatic abdominal injuries in children are treated with conservative nonsurgical management, traumatic perforation or infarction of the gastrointestinal tract still necessitates surgical management. It is imperative to recognize the often subtle computed tomographic (CT) findings of bowel or mesenteric trauma in children. Pediatric patients with bowel perforation or infarction due to trauma usually demonstrate multiple abnormalities at CT. A specific history of lap belt injury, bicycle handlebar injury, or child abuse with an abdominal injury should heighten suspicion for a bowel injury. CT findings in children with bowel or mesenteric trauma include free intraperitoneal air, free retroperitoneal air, extraluminal oral contrast material, free intraperitoneal fluid, bowel wall defect, bowel wall thickening, mesenteric stranding, fluid at the mesenteric root, focal hematoma, active hemorrhage, and mesenteric pseudoaneurysm. Some findings, such as free intraperitoneal air and focal bowel wall thickening, are associated with a strong likelihood of a bowel injury that requires surgical repair. Other findings, such as free intraperitoneal fluid, mesenteric stranding, fluid at the mesenteric root, and focal hematoma, are less specific for an injury that requires surgical repair. The hypoperfusion complex can usually be differentiated from a traumatic bowel injury; however, in some patients the imaging findings overlap.