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The value of CT in detecting bowel perforation in children after blunt abdominal trauma
D I Bulas1, G A Taylor, M R Eichelberger
1Department of Radiology, Children's Hospital National Medical Center, Washington, DC.
Insights
In children with blunt abdominal trauma, computed tomography (CT) can detect bowel perforation. However, free air on CT scans is not always specific for bowel perforation, requiring careful interpretation of secondary signs.
Area of Science:
- Pediatric Surgery
- Diagnostic Imaging
- Trauma Management
Background:
- Conservative management is preferred for pediatric blunt abdominal trauma.
- Delayed diagnosis of bowel perforation remains a concern.
- Accurate and timely diagnosis is crucial for optimal outcomes.
Purpose of the Study:
- To evaluate the sensitivity of computed tomography (CT) in detecting bowel perforation in children with blunt abdominal trauma.
- To assess the specificity of pneumoperitoneum on CT scans in this patient population.
Main Methods:
- Retrospective review of CT examinations in 547 children with blunt abdominal trauma.
- Analysis of CT findings, including free intraperitoneal air and secondary signs of bowel injury.
- Correlation of imaging findings with documented diagnoses of bowel perforation.
Main Results:
- Six patients (1%) had documented bowel perforation.
- CT detected free intraperitoneal air in 67% of perforated cases.
- Pneumoperitoneum was present in 9 patients, but only 44% had bowel perforation; other causes included pneumomediastinum and bladder perforation.
- Secondary signs like bowel wall thickening and unexplained peritoneal fluid were noted in cases without free air.
Conclusions:
- CT findings of pneumoperitoneum are useful but not specific for bowel perforation in pediatric blunt abdominal trauma.
- Secondary CT signs are important indicators of bowel perforation when free air is absent.
- Careful interpretation of CT in conjunction with clinical findings is essential for diagnosing bowel perforation in pediatric trauma.
Abstract:
In this era of conservative management for most infants and children with blunt abdominal trauma, there is a concern that the diagnosis of bowel perforation may be missed or delayed. To determine the sensitivity of CT in the detection of perforated viscus in this population, we reviewed the CT examinations of 547 consecutive children who had had blunt abdominal trauma. Of six patients (1%) with documented bowel perforation, four (67%) had free intraperitoneal air detected preoperatively by CT. The remaining two cases had secondary signs of bowel thickening and unexplained peritoneal fluid. Free intraperitoneal air was not a specific indicator for bowel perforation. Of nine patients in whom CT studies showed pneumoperitoneum, only four (44%) had a ruptured bowel. The remaining five patients had pneumoperitoneum from sources other than bowel perforation including pneumomediastinum, bladder perforation, and previous peritoneal lavage. This experience shows that the CT finding of pneumoperitoneum is useful, although not specific for the detection of bowel perforation in children with blunt abdominal trauma. When free air is not present, secondary signs of bowel wall thickening and unexplained peritoneal fluid suggest a bowel perforation.