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Pediatric duodenal perforation missed on computed tomography
1Department of Emergency Medicine, Kern Medical Center, Los Angeles, CA, USA.
Insights
Blunt abdominal trauma in children can cause subtle duodenal perforations. Early diagnosis relies on monitoring liver enzymes and pancreatic enzymes, as imaging is often unreliable for detecting hollow viscus injuries.
Area of Science:
- Pediatric Surgery
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Blunt abdominal trauma is a significant cause of injury in children.
- Gastrointestinal perforation following blunt trauma can present insidiously.
- Hollow viscus injuries may not be immediately apparent on initial diagnostic workups.
Abstract:
We present the case of a 2-year-old child who sustained duodenal perforation after blunt abdominal trauma. The presentation of gastrointestinal perforation after blunt abdominal trauma in children can be subtle and at times delayed. A slight increase in the concentration of aspartate aminotransferase, alanine aminotransferase, or pancreatic enzymes may be the only indication of hollow viscus injury. Initial radiographic studies have a low yield in detecting such injuries. Computed tomography is also unreliable. Conservative management with serial examinations and serial laboratory studies may be required to identify gastrointestinal perforation.