IMAGING GASTROINTESTINAL PERFORATION IN PEDIATRIC BLUNT ABDOMINAL-TRAUMA

Objective. To assess the role of imaging, in particular CT, in the ear ly detection of GI perforation. Subjects and methods. In a 10-year per iod, 43 patients with surgically confirmed GI perforation were identif ied from hospital records; 22 of these had preoperative CT evaluation. Medical records and radiology were retrospectively reviewed and CT st udies were particularly assessed for extraluminal air, free intraperit oneal fluid, bowel wall thickening, bowel wall enhancement, and bowel dilatation. During the study period an additional 12 trauma patients w ere identified who had CT studies demonstrating the above findings, bu t who had hypovolemic shock bowel or nondisrupting bowel injury withou t perforation evident. Results. Extraluminal air was demonstrated in 4 7% of the imaged perforations. There was one false-positive extralumin al 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 prese nt in all CT studies reviewed. No false-negative CT study was performe d in the study period. Conclusion. Separating nondisrupting bowel inju ry 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 al l potential perforation victims.