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Gastrointestinal tract perforation in children due to blunt abdominal trauma
1Department of Paediatric Surgery, Institute of Child Health, Red Cross Children's Hospital, Cape Town, South Africa.
Insights
Blunt abdominal trauma in children can cause bowel rupture, but initial clinical and radiological signs are often misleading. Frequent clinical re-evaluation is crucial for timely diagnosis and surgical intervention.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Abdominal Trauma
Background:
- Blunt abdominal trauma is a significant cause of injury in children.
- Bowel rupture is a severe complication requiring prompt diagnosis and management.
Purpose of the Study:
- To evaluate the diagnostic accuracy of clinical and radiological findings in pediatric blunt abdominal trauma.
- To identify delays in diagnosis and treatment of bowel rupture in children.
Main Methods:
- Retrospective review of 587 children under 13 admitted with blunt abdominal trauma over 14 years.
- Analysis of clinical presentation, radiological findings (including pneumoperitoneum), and time to laparotomy.
- Assessment of associated injuries and outcomes.
Main Results:
- Bowel rupture occurred in 4.9% of children.
- Clinical signs of peritonitis were present in 38% of those with rupture.
- Radiological evidence of perforation was low (19% for pneumoperitoneum, 22% for dilated bowel/fluid levels), with 59% of radiographs non-diagnostic.
- Mean time to laparotomy was 17 hours.
- Proximal bowel perforation was common, and 59% had concomitant injuries.
Conclusions:
- Initial clinical and radiological signs of bowel perforation in pediatric blunt abdominal trauma are often unreliable, leading to diagnostic delays.
- Repeated clinical examinations are essential, and progression of abdominal signs should prompt urgent laparotomy.
- Early surgical intervention is critical for improving outcomes in pediatric bowel rupture due to trauma.
Abstract:
Over a 14-year period 587 children under 13 years of age were admitted with blunt injury to the abdomen. Twenty-nine (4.9 per cent) of these were found to have bowel rupture. Evidence of peritonitis was present at initial evaluation in 11 children (38 per cent). Radiological evidence of perforation (pneumoperitoneum) was present in only five of 27 (19 per cent) with a further six of 27 (22 per cent) showing dilated loops of bowel or fluid levels. Thus 59 per cent of radiographs were not diagnostic. The mean time from admission to laparotomy was 17 h. Proximal bowel perforation was common and perforation at multiple sites occurred in five patients; 59 per cent had a concomitant injury which resulted in two deaths (from head injury). Initial clinical and radiological evidence of bowel perforation can be misleading and reliance on such indicators may result in significant diagnostic delay. Frequently repeated clinical examination is advocated; progression of abdominal signs should alert the clinician to proceed to laparotomy.