I. Ulman et al., GASTROINTESTINAL PERFORATIONS IN CHILDREN - A CONTINUING CHALLENGE TONONOPERATIVE TREATMENT OF BLUNT ABDOMINAL-TRAUMA, The journal of trauma, injury, infection, and critical care, 41(1), 1996, pp. 110-113
The present trend towards conservative management of hemodynamically s
table pediatric trauma patients may be increasing the risk of delay in
the diagnosis of traumatic hollow viscus perforations (HVP). The purp
ose of this study is to determine whether there is a delay in the diag
nosis of HVP because of expectant management, A survey of factors lead
ing to diagnostic delay was also made and the value of current diagnos
tic tools were reevaluated. In 1,283 trauma admissions between 1980-19
94, 34 patients were operated for HVP caused by blunt abdominal trauma
, Sites of perforation were; stomach (four), duodenum (five), jejunum
(12), ileum (nine), and jejunum/ileum (four). Signs of peritoneal irri
tation were positive in 32 of 34 patients, There was free air in only
six of: 24 abdominal roentgenograms. Free peritoneal fluid without sol
id organ injury was detected in only four out of 13 patients with ultr
asound, Peritoneal lavage was diagnostic in eight of nine patients. Ti
me from admission to operating room averaged 24 +/- 4.1 (mean +/- stan
dard deviation) hours, Eleven patients died after the operation mostly
because of accompanying head injury, Only two of the deaths were the
result of sepsis originating from the perforated bowel. There is an ap
parent delay in the diagnosis of traumatic HVP in this series, Signs o
f peritoneal irritation are the most consistent findings of HVP after
blunt abdominal trauma in children, Persistence of abdominal signs ind
icates peritoneal lavage, which has a high diagnostic sensitivity for
HVP compared to other diagnostic modalities.