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Intestinal stricture following seat belt injury in children
J M Lynch1, C T Albanese, M P Meza
1Benedum Pediatric Trauma Program, Children's Hospital of Pittsburgh, PA 15213-2583, USA.
Insights
Seat belts can cause intestinal perforation in children, sometimes leading to late-developing posttraumatic intestinal stricture (PTIS). This study proposes a unique pediatric mechanism for PTIS and offers treatment recommendations for this rare complication.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Seat belt use is crucial for safety but can cause intestinal injuries.
- Intestinal perforation is a common seat belt injury in children.
- Posttraumatic intestinal stricture (PTIS) is a rare but serious late complication.
Observation:
- A literature review identified common clinical presentations of PTIS in children and adults.
- A distinct pathophysiological mechanism for PTIS in pediatric patients was noted compared to adults.
- Two pediatric cases of PTIS following blunt intestinal injury from seat belts were recently treated.
Findings:
- The study proposes a specific pathophysiological mechanism for PTIS in children.
- Differences in injury mechanisms between pediatric and adult PTIS are highlighted.
- Clinical patterns of PTIS presentation are common across age groups.
Implications:
- Understanding the pediatric-specific mechanism can improve diagnosis and treatment of PTIS.
- Early recognition and management are crucial for favorable outcomes in pediatric blunt intestinal injuries.
- Recommendations for the evaluation and treatment of seat belt-related intestinal complications are provided.
Abstract:
The most commonly reported intestinal injury from seat belts in children is perforation. A rarely reported late sequela following this type of injury is posttraumatic intestinal stricture (PTIS). A review of the literature reveals a common clinical pattern of presentation in children and adults but an apparent difference in the pathophysiologic mechanism between the pediatric and adult patient. Recently, we treated two children with PTIS. Each case is discussed, and a pathophysiological mechanism for this injury in children is proposed. Recommendations are made for the evaluation and treatment of these uncommon complications of seat belt-related blunt intestinal injury.