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[Traumatic perforation of the small intestine in childhood]
C Baeza-Herrera1, L M García-Cabello, R Gardida-Chavarria
1Departamento de Cirugía General del Hospital Pediátrico Moctezuma, México, D.F.
Insights
Traumatic small bowel perforation in children requires prompt surgical intervention. Early recognition and diagnosis are crucial for excellent outcomes in pediatric abdominal trauma cases.
Area of Science:
- Pediatric Surgery
- Abdominal Trauma
- Gastrointestinal Injury
Context:
- Traumatic small bowel perforation occurs in ~1% of pediatric abdominal trauma cases.
- Delayed diagnosis of hollow viscus injury can lead to poor outcomes.
- Understanding injury patterns is vital for effective management.
Purpose:
- To review pediatric traumatic small bowel perforations.
- To analyze injury mechanisms, patient demographics, and outcomes.
- To emphasize the importance of timely diagnosis and surgical intervention.
Summary:
- A review of 41 pediatric cases (1991-1999) revealed blunt trauma as the primary cause (37 cases).
- Jejunal (21) and ileal (16) perforations were most common, with associated injuries in 11 patients.
- Simple closure was performed in 29 patients; 4 children died, highlighting the severity of these injuries.
Impact:
- Prompt surgical intervention is key for curable outcomes in pediatric small bowel perforation.
- Alertness to subtle signs and accurate diagnosis improve prognosis.
- Effective management of associated injuries is critical for survival.
Introduction:
Traumatic perforation of the small bowel occurs in approximately 1 percent of children with either blunt or penetrating trauma to the abdomen. Difficulty in recognition of initial subtle signs of hollow viscus injury can lead to delay in both diagnosis and operative intervention.
Material And Method:
Medical records for patients discharged with traumatic small bowel perforation from the General Surgery Department between 1991 and 1999 were reviewed.
Results:
Bowel injuries were noted in 41 children. Blunt trauma (battered child syndrome, bike injuries, etc.), was responsible for 37 cases and penetrating wounds in three (firearm wounds and bike pedal accidents). There were 32 boys and a mean age of 6.8 years. The site of perforation was duodenal in four cases, jejunum in 21, and ileum in sixteen. Associated injuries occurred in 11 patients, including stomach, pancreas, liver, spleen, bladder, and ureter. Twenty-nine had simple closure, while seven were resected. Four children died.
Conclusions:
These injuries require prompt surgical intervention and are in general curable with excellent prognosis if one is alert to the possibility of their occurrence, if one is familiar with the approaches to prompt and accurate diagnosis, and if associated injuries are not serious.