IS COMPUTED-TOMOGRAPHY A USEFUL ADJUNCT TO THE CLINICAL EXAMINATION FOR THE DIAGNOSIS OF PEDIATRIC GASTROINTESTINAL PERFORATION FROM BLUNT ABDOMINAL-TRAUMA IN CHILDREN

Perforations of the gastrointestinal (GI) tract, compared to solid org an injuries, are a relatively infrequent sequela of blunt abdominal tr auma in children, The purpose of this study is to review retrospective ly the diagnostic modalities used in 30 children with proven traumatic intestinal perforations treated at one institution. Since computed to mography with intravenous and oral GI contrast is commonly used in the diagnosis of suspected solid organ injury from blunt abdominal trauma , we evaluated retrospectively the computed tomographic (CT) scan find ings in these children in an attempt to accurately predict or suggest GI perforation, Between January 1987 and December 1993, 5,795 children were admitted, Three hundred fifty suffered blunt abdominal trauma of which 30 patients (8.5%) required surgery for a GI perforation and fo rmed the basis for this study. Data collected were mechanisms of injur y, results of admission and serial clinical examinations, results of r adiologic imaging, associated injuries, operative findings, and outcom e, Follow-up was obtained on all patients and averaged 2.5 years, Blow s to the abdomen (handlebars, cars, kicks) were the most common cause of perforation, followed by seatbelt injuries, Eleven patients underwe nt immediate laparotomy an average of 0.75 hours after admission, The indication for surgery was shock (three), clinically apparent peritoni tis (five), and free air on plain abdominal radiograph (three), Ninete en patients underwent ''later'' laparotomy, an average of 3.4 hours af ter admission, all because of the eventual development of peritonitis, Retrospective review of these CT scans revealed free air anterior to the liver in three, and the remaining 16 had CT findings suggestive of GI injury such as free fluid, focal fluid-filled thick-walled bowel l oops, and mesenteric infiltration, There were five (26%) false negativ e CT scans performed an average of 5.0 hours after injury, We believe serial physical examinations are the gold standard for diagnosing pedi atric GI perforation from blunt abdominal trauma, The CT scan may be a useful adjunct to the diagnosis of an intestinal perforation in patie nts who have no immediate indication for surgery, Presently, the only CT finding that is an absolute indication for laparotomy is free air ( in the absence of pulmonary/mediastinal injury or barotrauma), The oth er CT ''findings'' need to be validated prospectively.