Oral contrast with computed tomography in the evaluation of blunt abdominal trauma in children

Background: The use of oral contrast in evaluating children by computed tom ography (CT) following blunt trauma is controversial. The aim of this study was to evaluate retrospectively the use of oral contrast with abdominal CT in children with suspected abdominal injury. Methods: The medical records of 101 children who underwent CT for abdominal trauma between 1993 and 1997 were reviewed for data pertaining to the mech anism of injury, clinical findings and management. Scans were reviewed by a paediatric radiologist and criteria of intestinal injury on CT described b y Cox and Kuhn were used: (1) extraluminal air or contrast material, (2) fo cal area of thickening of bowel wall and mesentery, and (3) free intraperit oneal fluid in the absence of solid organ injury. Results: CT was performed within a median time of 2.4 (range 1-48) h after the injury. On 37 (62 per cent) of 60 scans in children who had oral contra st, the duodenum was not opacified after a mean delay of 30 min. Intestinal injury was suspected on CT in four children. In two children with CT evide nce of intestinal injury (with/without oral contrast) rupture of the duoden ojejunal flexure (n = 1) or ileal perforation (n = 1) was found at laparoto my. Two children had a false-positive scan, leading to negative laparotomy; one scan with oral contrast incorrectly suggested a duodenal leak and in a nother child CT without oral contrast showed thickening of bowel wall with free intraperitoneal fluid but no specific intestinal injury was identified at laparotomy. One patient had two negative CT scans (with and without ora l contrast) and underwent laparotomy for clinical suspicion of bowel injury ; rupture of the splenic flexure of the colon was found at laparotomy. Conclusion: CT is not reliable for diagnosing intestinal injuries and this is not improved by use of oral contrast. Omission of oral contrast was not associated with delay in the diagnosis of intestinal injury. Since intestin al injuries are uncommon in children, a prospective multicentre study would determine more precisely the role of the routine use of oral contrast.