Blunt traumatic injuries of the gastrointestinal and biliary tract in childhood. Analysis of 16 cases

Background: Little attention has been given to abdominal hollow viscus inju ries in pediatric literature. The purpose of this report is to describe the ir main features, and the current methods of diagnosis and treatment. Metho ds: We reviewed our experience with 16 cases of blunt injuries involving th e gastrointestinal (GI) and biliary tract in the last seven years. Results: Male to female ratio was 0.68 and mean age 9.4 years. The site of injury w as the stomach in 2 cases, duodenum in 5, jejunum or ileum in 7, caecum in 2, left mesocolon in 2, and gallbladder in 1. Diagnosis of the 8 perforatio ns was clinically suspected in 6, and confirmed by radiography in 6 or surg ery in 2, with a mean delay of 0.42 days. Diagnosis of the 11 hematomas was clinically suspected in 6, and confirmed by radiography in 9 or surgery in 2, with a mean delay of 12.6 days. Hematomas were managed nonoperatively, and perforations were surgically or laparoscopically closed. Mortality was 1/16 by pancreatic injury, and morbidity was 4/16. Conclusion: Incidence of blunt hollow viscus injuries is low in children. Hematomas are easily reco gnized by modern radiography, and simply managed nonoperatively. Diagnosis of perforations still remains difficult. This results in dangerous delays f or lesions which need prompt repair.