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Small bowel injury in children after blunt abdominal trauma: is diagnostic delay important?
D D Bensard1, B L Beaver, G E Besner
1Department of Surgery, Children's Hospital, University of Colorado 80218, USA.
Insights
Small bowel injury (SBI) is uncommon in pediatric blunt abdominal trauma. Clinical diagnosis is safe, allowing nonoperative management for most cases and reducing unnecessary surgeries.
Area of Science:
- Pediatric Surgery
- Trauma Care
- Abdominal Imaging
Background:
- Blunt abdominal trauma is a significant concern in pediatric patients.
- Nonoperative management is increasingly preferred for intra-abdominal injuries when feasible.
Purpose of the Study:
- To determine the incidence and outcomes of small bowel injury (SBI) in children with blunt abdominal trauma.
- To evaluate the safety and efficacy of nonoperative management strategies for SBI.
Main Methods:
- Retrospective chart review of 168 hemodynamically stable children admitted to a Level I pediatric trauma center.
- Analysis of diagnostic methods, including computed tomographic (CT) scans, and clinical findings.
- Assessment of operative versus nonoperative management and patient outcomes.
Main Results:
- Small bowel injury (SBI) occurred in 5% (9/168) of children.
- Three patients required early operation for recognized SBI on CT; six had delayed operations for missed SBI.
- Clinical indicators like fever, tachycardia, and decreased urine output suggested occult SBI, but delayed diagnosis did not impact hospital course.
- Overall, 90% of children were discharged without laparotomy.
Conclusions:
- Small bowel injury (SBI) is infrequent in pediatric blunt abdominal trauma.
- Clinical and radiographic findings aid in diagnosing SBI.
- Limited diagnostic delays do not adversely affect outcomes, supporting clinical diagnosis for safe nonoperative management and reduced laparotomy rates.
Objective:
To assess the incidence and consequences of small bowel injury (SBI) in children suffering blunt abdominal trauma managed with the intent to treat nonoperatively.
Design:
Retrospective chart review.
Materials And Methods:
A total of 168 consecutive hemodynamically stable children admitted to a Level I pediatric trauma center during a 24-month period.
Results:
Nine of 168 children (5%) sustained SBI: three underwent early (< 4 hours) operation for recognized SBI (identified on computed tomographic scan); and six had delayed (36 +/- 16 hours) operation for missed SBI (not identified on computed tomographic scan). Increased temperature and heart rate, or decreased urine output at 24 hours suggested occult SBI. The hospital course was unaltered by delayed diagnosis. Fifty-seven percent of the children (95) suffered intra-abdominal injury; 10% required laparotomy for SBI (9) or solid organ injury (7); 90% (152) were discharged without laparotomy.
Conclusions:
SBI is uncommon in children suffering blunt abdominal trauma. The diagnosis can be made using clinical and radiographic findings. Limited diagnostic delay does not seem to affect outcome. We conclude that clinical diagnosis of SBI is safe, permits the nonoperative treatment of most blunt abdominal injuries, and reduces the risk of unnecessary laparotomy associated with alternate approaches.