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Published on: December 1, 2012
Small bowel injuries in children
A J Holland1, D T Cass, M J Glasson
1Department of Surgical Research and Douglas Cohen Department of Paediatric Surgery, The New Children's Hospital, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia.
Insights
Persistent tachycardia in children after blunt abdominal trauma may indicate small bowel injury (SBI). Delayed diagnosis of SBI can lead to severe complications and death.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Abdominal Imaging
Background:
- Small bowel injury (SBI) is a critical consequence of blunt abdominal trauma in children.
- Early identification and management of SBI are crucial for patient outcomes.
Purpose of the Study:
- To identify common features of pediatric small bowel injury.
- To investigate the consequences of delayed diagnosis in these cases.
Main Methods:
- Retrospective case review of children diagnosed with traumatic SBI.
- Data collected from January 1988 to November 1999.
Main Results:
- Twenty-eight pediatric patients with SBI were identified; 71% resulted from road trauma.
- Tachycardia was a common finding (82%), especially with intestinal perforations.
- Abnormal CT scans with contrast accurately detected perforations and mesenteric tears; diagnosis was delayed in 6 patients, leading to one death from sepsis.
Conclusions:
- Persistent tachycardia following blunt abdominal trauma necessitates the exclusion of SBI.
- Delayed diagnosis of pediatric small bowel injury is linked to increased morbidity and mortality.
Objective:
To determine the common features of small bowel injury (SBI) in childhood and the consequences of delayed diagnosis.
Methodology:
A retrospective case review was performed of children with traumatic SBI between January 1988 and November 1999.
Results:
Twenty-eight patients were identified with SBI. Road trauma accounted for 71% of them. Tachycardia was present on admission in 82% of patients with SBI including all but one of the intestinal perforations. SBI was associated with a Chance fracture of the lumbar spine in three patients (11%). An abdominal computed tomography scan with intravenous contrast was abnormal in all patients with a perforation or mesenteric tear. Diagnosis was delayed in six patients, one of whom died as a result of sepsis from a small bowel perforation.
Conclusions:
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.
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