F. Hulka et al., SIGNIFICANCE OF PERITONEAL-FLUID AS AN ISOLATED FINDING ON ABDOMINAL COMPUTED TOMOGRAPHIC SCANS IN PEDIATRIC TRAUMA PATIENTS, The journal of trauma, injury, infection, and critical care, 44(6), 1998, pp. 1069-1072
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.