Related Experiment Videos
Delay in diagnosing gastrointestinal injury after blunt abdominal trauma in children
Insights
Diagnosing intestinal perforation in children after blunt abdominal trauma can be delayed. This study recommends serial imaging and radionuclide scanning to improve early detection of jejunal perforations.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Diagnostic Imaging
Background:
- Intestinal perforation following blunt abdominal trauma in children is infrequent, often leading to diagnostic delays.
- Early and accurate diagnosis is crucial for timely intervention and improved patient outcomes.
Purpose of the Study:
- To review the authors' experience with 12 pediatric cases of intestinal perforation due to blunt abdominal trauma.
- To propose an optimized diagnostic protocol to minimize delays in identifying intestinal injuries.
Main Methods:
- Retrospective review of 12 children diagnosed with intestinal perforation after blunt abdominal trauma.
- Analysis of diagnostic methods, including radiography, serial imaging, and radionuclide scanning.
- Categorization of perforation sites: gastric, duodenal, jejunal, and colonic.
Main Results:
- Jejunal perforations (7 cases) were particularly prone to delayed diagnosis, often due to the absence of initial radiological signs of free air.
- Delayed rupture or intestinal spasm may contribute to the delayed presentation of free air.
- Serial radiographic films and radionuclide scanning for solid organ injury assessment proved valuable.
Conclusions:
- A protocol incorporating serial imaging and radionuclide scanning is recommended to expedite the diagnosis of intestinal perforation in pediatric blunt abdominal trauma.
- Prompt diagnosis and management are essential, as evidenced by no mortality in this series.
Abstract:
Intestinal perforation after blunt abdominal trauma in children is rare and thus the diagnosis may be delayed. For this reason the authors reviewed their experience with 12 children to recommend a protocol for investigation that would reduce the delay in diagnosis. Of the 12 perforations, 2 were gastric, 2 duodenal, 7 jejunal and 1 colonic. The diagnosis of jejunal perforation, in particular, was usually delayed because free air was not seen radiologically in the first few hours after injury. This may be because of delayed rupture or spasm of the injured intestine. Serial films were valuable in aiding the diagnosis and are recommended, together with assessment of solid organ injury by radionuclide scanning. In this series peritoneal lavage was not used. No child died.