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Gastrointestinal injuries in childhood: analysis of 53 patients
J L Grosfeld1, F J Rescorla, K W West
1Department of Surgery, Indiana University School of Medicine, Indianapolis.
Insights
Blunt trauma is the leading cause of pediatric gastrointestinal injuries, often affecting the jejunum and ileum. Prompt diagnosis and surgical intervention are crucial for improving survival rates in these cases.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Gastrointestinal (GI) injuries in children are relatively uncommon but can lead to significant morbidity.
- Blunt abdominal trauma is the most frequent cause of pediatric GI injuries.
Purpose of the Study:
- To analyze the epidemiology, management, and outcomes of pediatric gastrointestinal injuries.
- To identify patterns of injury, diagnostic methods, and treatment strategies.
Main Methods:
- Retrospective review of pediatric patients with GI injuries over a specified period.
- Data collection included demographics, injury mechanisms, injury sites, diagnostic modalities, associated injuries, treatments, complications, and outcomes.
- Statistical analysis of injury patterns and treatment efficacy.
Main Results:
- 53 children sustained GI injuries, predominantly from blunt trauma (51 cases).
- Common injury sites included the duodenum (17), jejunum (19), and ileum (15).
- Management varied, with non-operative resolution for duodenal hematomas and surgical repair (closure or resection) for perforations and mesenteric avulsions. Complications occurred in 13 patients, including atelectasis, pseudocyst, and sepsis. Mortality was 1.8%.
Conclusions:
- Blunt trauma is the primary cause of pediatric GI injuries, with jejunoileal injuries being most prevalent.
- Early diagnosis utilizing imaging (X-ray, CT) and clinical assessment is vital.
- Appropriate surgical management, tailored to injury type, improves patient outcomes and survival.
Abstract:
Gastrointestinal injuries were noted in 53 children. Blunt trauma was responsible for 51 cases, and penetrating wounds in two. There were 42 boys and 11 girls (mean age, 8.1 years). The site of injury was the stomach (2), duodenum (17), jejunum (19), and ileum (15). Types of injury included two gastric perforations, 16 duodenal hematomas, one duodenal laceration, 27 jejunoileal perforations, five mesenteric avulsions, one abdominal wall laceration and evisceration, and one entrapment necrosis between lumbar vertebrae. Diagnosis was accomplished by observing free air on x-ray, with contrast (duodenal haematoma), computed tomography, and frequent examination (noting peritoneal irritation). Thirty-four associated injuries occurred in 21 patients (40%) including the liver (6), pancreas (6), skeletal injury (6), head trauma (5), diaphragm (4), lung (3), spleen (2), and kidney (2). Nine of 16 duodenal hematomas resolved non-operatively, while seven were evacuated during other procedures. Twenty-three of 30 perforations had simple closure, while seven (jejunoileal) were resected. Mesenteric avulsions required resection in five cases--the eviscerated bowel was replaced and the entrapped bowel resected. Twenty complications occurred in 13 patients, including atelectases (6), pseudocyst (5), sepsis (4), wound infection (2), subhepatic abscess (1), subglottic stenosis (1), and short bowel syndrome (1). One infant (aged 2 months) with a duodenal laceration died of head injuries (1/53 = 1.8% mortality). Prompt recognition and appropriate treatment result in improved survival.