SIGNIFICANCE OF PERITONEAL-FLUID AS AN ISOLATED FINDING ON ABDOMINAL COMPUTED TOMOGRAPHIC SCANS IN PEDIATRIC TRAUMA PATIENTS

Background: Peritoneal fluid on abdominal computed tomographic (CT) sc an in the absence of solid-organ injury suggests a bowel injury. We so ught to determine the significance of peritoneal fluid as the sole fin ding on abdominal CT scans obtained to evaluate injured pediatric pati ents. Methods: We performed a retrospective review of abdominal CT sca ns obtained during the initial survey of blunt trauma patients less th an 19 years old during a 5-year period (1991-1995), All patients recei ved intravenous and oral contrast agents. All CT scans were read by a staff radiologist, All CT scan results were retrospectively verified b y one of the authors, Results: Of the 259 scans, 157 (59%) were read a s normal; 76 (31%) demonstrated solid-organ injury or pelvic fracture; 2 (1%) had pneumoperitoneum and 24 (9%) had peritoneal fluid as the o nly finding. Quantification of the fluid was done using a previously d escribed method. Of the 16 patients with a small amount of fluid, only 2 (12%) required celiotomy, Of the eight patients with a moderate amo unt of fluid, four (50%) required celiotomy, At celiotomy, the six pat ients all had small-bowel injuries, No abdominal CT scan demonstrated extravasation of oral contrast, Conclusion: Intra-abdominal fluid as t he sole finding on abdominal CT scan does not mandate immediate celiot omy in the bluntly injured pediatric patient. The patient with fluid i n more than one location has a 50% chance of bowel injury. We also con clude that extravasated enteral contrast is rarely present to aid in t he diagnosis of bowel injury in children.