Skip to main content
Log in

Imaging gastrointestinal perforation in pediatric blunt abdominal trauma

  • Published:
Pediatric Radiology Aims and scope Submit manuscript

Abstract

Objective. To assess the role of imaging, in particular CT, in the early detection of GI perforation.

Subjects and methods. In a 10-year period, 43 patients with surgically confirmed GI perforation were identified from hospital records; 22 of these had preoperative CT evaluation. Medical records and radiology were retrospectively reviewed and CT studies were particularly assessed for extraluminal air, free intraperitoneal fluid, bowel wall thickening, bowel wall enhancement, and bowel dilatation. During the study period an additional 12 trauma patients were identified who had CT studies demonstrating the above findings, but who had hypovolemic shock bowel or nondisrupting bowel injury without perforation evident.

Results. Extraluminal air was demonstrated in 47% of the imaged perforations. There was one false-positive extraluminal air. Perforation was confirmed in patients who had all five of the above CT findings, but this was the case for only 18% of patients with perforation. One or more of the five specified CT findings were present in all CT studies reviewed. No false-negative CT study was performed in the study period.

Conclusion. Separating nondisrupting bowel injury from perforation is diagnostically difficult; however, CT remains a good modality for assessing GI perforation in pediatric blunt trauma, but it cannot replace diligent and repeated clinical evaluation of all potential perforation victims.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Kaufman RA, Towbin R, Babcock DS, Gelfand MJ, Guice KS, Oldham KT, Noseworthy J (1984) Upper abdominal trauma in children: imaging evaluation. AJR 142: 449–460

    PubMed  Google Scholar 

  2. Wing VW, Federle MP, Morris JA, Brooke Jeffrey R, Bluth R (1985) The clinical impact of CT for blunt abdominal trauma. AJR 145:1191–1194

    PubMed  Google Scholar 

  3. Brown RA, Bass DH, Rode H, Millar AJH, Cywes S (1992) Gastrointestinal tract perforation in children due to blunt abdominal trauma. Br J Surg 79: 522–524

    PubMed  Google Scholar 

  4. Kovacs GZ, Davies MRO, Saunders W, Fonseca J, Gose C (1986) Hollow viscus rupture due to blunt trauma. Surg Gynecol Obstet 163: 552–554

    PubMed  Google Scholar 

  5. Sivit CJ, Eichelberger MR, Taylor GA (1994) CT in children with rupture of the bowel caused by blunt trauma: diagnostic efficacy and comparison with hypoperfusion complex. AJR 163: 1195–1198

    PubMed  Google Scholar 

  6. Bulas DI, Taylor GA, Eichelberger MR (1989) The value of CT in detecting bowel perforation in children after blunt abdominal trauma. AJR 152:561–564

    PubMed  Google Scholar 

  7. Hara H, Babyn P, Bourgeois D (1992) Significance of bowel wall enhancement on CT following blunt abdominal trauma in childhood. J Comput Assist Tomogr 16: 94–97

    PubMed  Google Scholar 

  8. Sherck JP, Oakes DD (1990) Intestinal injuries missed by computed tomography. J Trauma 30: 1–7

    PubMed  Google Scholar 

  9. Wisner DH, Chun Y, Blaisdell FW (1990) Blunt intestinal injury. Arch Surg 125: 1319–1323

    PubMed  Google Scholar 

  10. Sivit CJ, Taylor GA, Newman KD, Bulas DI, Gotschall CS, Wright CJ, Eichelberger MR (1991) Safety belt injury in children with lap belt ecchymosis: CT findings in 61 patients. AJR 157: 111–114

    PubMed  Google Scholar 

  11. Sivit CJ, Taylor GA, Bulas DI, Bowman BA, Eichelberger MR (1991) Blunt trauma in children: significance of peritoneal fluid. Radiology 178: 185–188

    PubMed  Google Scholar 

  12. Taylor GA, Fallat ME, Eichelberger MR (1987) Hypovolemic shock in children: abdominal CT manifestations. Radiology 164: 479–481

    PubMed  Google Scholar 

  13. Clancy TV, Ragozzino MW, Ramshaw D, Paige Churchill M, Covington DL, Maxwell JG (1993) Oral contrast is not necessary in the evaluation of the blunt abdominal trauma by computed tomography. Am J Surg 166: 680–684

    PubMed  Google Scholar 

  14. Cook DE, Walsh JW, Vick WC, Brewer WH (1989) Upper abdominal trauma: pitfalls in CT diagnosis. Radiology 159: 65–69

    Google Scholar 

  15. Hofer GA, Cohen AJ (1989) CT signs of duodenal perforation secondary to blunt abdominal trauma. J Comput Assist Tomogr 13: 430–432

    PubMed  Google Scholar 

  16. Stevens SL, Maull KI (1990) Small bowel injuries. Surg Clin North Am 70: 541–560

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jamieson, D.H., Babyn, P.S. & Pearl, R. Imaging gastrointestinal perforation in pediatric blunt abdominal trauma. Pediatr Radiol 26, 188–194 (1996). https://doi.org/10.1007/BF01405296

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01405296

Keywords

Navigation