Blunt abdominal trauma and hollow viscus injury in children: the diagnostic value of plain radiography

Blunt abdominal trauma in children: risks of nonoperative treatment

This retrospective study includes 203 children who had intraabdominal injuries after blunt trauma, mainly bicycle accidents and falls. Of 145 patients with splenic injury, seven underwent surgery. There was a 100% splenic salvage rate. Twenty-nine children had hepatic injury and four underwent laparotomy. One patient who was initially treated conservatively had a complicated clinical course with rebleeding that led to two laparotomies. Three of 10 pancreatic injuries were operated on; one of them 4 weeks after the trauma because of a pseudocyst. Nineteen patients had gastrointestinal tract injuries. Of seven intramural hematomas, five were treated nonoperatively. Twelve patients had gastrointestinal perforations. Seven underwent laparotomy without delay. Three patients underwent surgery 24 hours after admission because of severe abdominal rigidity or pneumoperitoneum. There was one case of severe in-hospital delay in which splenic and hepatic injuries were thought to account for the physical findings. At laparotomy 36 hours after admission, a jejunal rupture and necrosis of the transverse colon were found. Nonoperative management of blunt abdominal trauma has been very successful regarding splenic ruptures. Conservative management of hepatic injuries is more hazardous, and treatment of pancreatic injuries is a matter of controversy. Gastrointestinal-tract perforations are difficult to diagnose and important to bear in mind while keeping a conservative attitude toward abdominal trauma.

Gastrointestinal tract perforation in children due to blunt abdominal trauma

Over a 14-year period 587 children under 13 years of age were admitted with blunt injury to the abdomen. Twenty-nine (4.9 per cent) of these were found to have bowel rupture. Evidence of peritonitis was present at initial evaluation in 11 children (38 per cent). Radiological evidence of perforation (pneumoperitoneum) was present in only five of 27 (19 per cent) with a further six of 27 (22 per cent) showing dilated loops of bowel or fluid levels. Thus 59 per cent of radiographs were not diagnostic. The mean time from admission to laparotomy was 17 h. Proximal bowel perforation was common and perforation at multiple sites occurred in five patients; 59 per cent had a concomitant injury which resulted in two deaths (from head injury). Initial clinical and radiological evidence of bowel perforation can be misleading and reliance on such indicators may result in significant diagnostic delay. Frequently repeated clinical examination is advocated; progression of abdominal signs should alert the clinician to proceed to laparotomy.

Diagnostic imaging for the evaluation of abdominal trauma in children

Trauma kills and maims more children each year than infections and neoplasms combined, and 10 per cent of trauma-related deaths are due to abdominal injury. This article examines the various modalities used in evaluating abdominal trauma, and discusses the imaging findings of injury of the organs of the abdomen.

Conventional abdominal radiography as a means to rule out ileo-caecal intussusception

The experiences gained with conventional radiographic examinations as a means of excluding childhood ileo-caecal intussusception are presented. According to these, a supplementary barium enema is indicated a) in patients under 6 months of age, b) in patients presenting with scant intestinal gas, c) in patients where the caecum cannot be outlined, d) in patients with a possible mass lesion of the colon, e) in patients with obstruction presumably due to intussusception, and f) in patients with discrepancy between the clinical and radiologic findings (1, 4). In all other patients the barium examination is not used. The key to a successful application of this protocol is a thorough familiarity with the limitations and potentials of the conventional abdominal examination.