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CT in children with rupture of the bowel caused by blunt trauma: diagnostic efficacy and comparison with
C J Sivit1, M R Eichelberger, G A Taylor
1Department of Diagnostic Imaging and Radiology, Children's National Medical Center, Washington, DC 20010.
Insights
Computed tomography (CT) accurately diagnoses bowel rupture in children following blunt trauma, with peritoneal fluid and bowel wall enhancement being key indicators. CT findings can overlap with the hypoperfusion complex.
Area of Science:
- Pediatric radiology
- Abdominal imaging
- Trauma imaging
Background:
- Blunt abdominal trauma in children can lead to serious injuries like bowel rupture.
- Accurate and timely diagnosis is crucial for effective management and improved outcomes.
- Computed tomography (CT) is a primary imaging modality for evaluating blunt abdominal trauma.
Purpose of the Study:
- To determine the sensitivity and specificity of CT in diagnosing bowel rupture in pediatric blunt trauma patients.
- To compare CT findings in children with bowel rupture versus those with the hypoperfusion complex.
Main Methods:
- Prospective evaluation of contrast-enhanced CT scans in 1488 children with blunt abdominal trauma.
- Analysis of specific CT findings: peritoneal fluid, extraluminal air, bowel wall enhancement, thickening, and dilatation.
- Correlation of CT findings with surgical or autopsy-verified diagnoses of bowel rupture.
Main Results:
- CT demonstrated high accuracy in diagnosing bowel rupture (sensitivity 95%, specificity 96%).
- The most frequent CT findings in bowel rupture were peritoneal fluid (67%) and bowel wall enhancement (62%).
- A hypoperfusion complex was identified in 33 children without bowel rupture but with positive CT findings.
Conclusions:
- CT is a highly accurate tool for diagnosing bowel rupture in children after blunt trauma.
- Peritoneal fluid and bowel wall enhancement are the most common CT indicators of bowel rupture.
- CT findings in bowel rupture can overlap with those seen in the hypoperfusion complex, necessitating careful interpretation.
Objective:
The purpose of this study was to determine the sensitivity and specificity of CT in diagnosing bowel rupture in children after blunt trauma and to compare CT findings in children with bowel rupture with those in children with the hypoperfusion complex.
Subjects And Methods:
Twenty-one (1%) of 1488 children who had contrast-enhanced CT of the abdomen after blunt trauma had a bowel rupture subsequently verified at surgery or autopsy. Thirty-three additional children had a characteristic hypoperfusion complex at CT. The CT scans in all 1488 children were prospectively evaluated for the following findings: peritoneal fluid, extraluminal air, bowel wall enhancement, bowel wall thickening, and bowel dilatation.
Results:
The most common CT findings in children with bowel rupture were peritoneal fluid (14, 67%) and bowel wall enhancement (13, 62%). One or more of the five studied CT findings were noted in 20 of the 21 children with bowel rupture and in 64 of the 1467 children without bowel rupture (sensitivity 95%, specificity 96%). Thirty-three children who had one or more of the CT findings and did not have bowel rupture had the hypoperfusion complex.
Conclusion:
Our results show that CT is accurate in the diagnosis of bowel rupture after blunt trauma in children. The most common findings are peritoneal fluid and bowel wall enhancement. CT findings in children with bowel rupture may overlap with those in children with the hypoperfusion complex.