Small bowel injury in children after blunt abdominal trauma: is diagnostic delay important?
OBJECTIVE
To assess the incidence and consequences of small bowel injury (SBI) in children suffering blunt abdominal trauma managed with the intent to treat nonoperatively.


METHODS
Retrospective chart review.


METHODS
A total of 168 consecutive hemodynamically stable children admitted to a Level I pediatric trauma center during a 24-month period.


RESULTS
Nine of 168 children (5%) sustained SBI: three underwent early (< 4 hours) operation for recognized SBI (identified on computed tomographic scan); and six had delayed (36 +/- 16 hours) operation for missed SBI (not identified on computed tomographic scan). Increased temperature and heart rate, or decreased urine output at 24 hours suggested occult SBI. The hospital course was unaltered by delayed diagnosis. Fifty-seven percent of the children (95) suffered intra-abdominal injury; 10% required laparotomy for SBI (9) or solid organ injury (7); 90% (152) were discharged without laparotomy.


CONCLUSIONS
SBI is uncommon in children suffering blunt abdominal trauma. The diagnosis can be made using clinical and radiographic findings. Limited diagnostic delay does not seem to affect outcome. We conclude that clinical diagnosis of SBI is safe, permits the nonoperative treatment of most blunt abdominal injuries, and reduces the risk of unnecessary laparotomy associated with alternate approaches.
Bensard
D D
DD
Department of Surgery, Children's Hospital, University of Colorado 80218, USA.
Beaver
B L
BL
Besner
G E
GE
Cooney
D R
DR
D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007421:Intestine, Small / Q000293:injuries*; D007813:Laparotomy; D008297:Male; D012189:Retrospective Studies; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis / Q000628:therapy