Management of gastrointestinal perforation from blunt and penetrating abdominal trauma in children: analysis of 96 patients.
OBJECTIVE
The objective of the present study was to evaluate the diagnostic methods, concomitant organ injuries, factors affecting mortality and morbidity, treatment methods, and outcomes of patients treated for traumatic gastrointestinal (GI) perforation.


METHODS
We conducted a retrospective review of the medical records of 96 patients who had been treated for GI perforation between January 2000 and October 2015. Data were collected and organised according to the following categories: general patient information, age, gender, hospitalisation period, trauma mechanisms, concomitant injuries, radiological assessment, diagnosis and treatment methods, treatment forms, and complications. The cases were divided into two groups, blunt and penetrating traumas, and the patients within each group were compared. Colorectal trauma cases were not included in this study. Patients suspected of a GI perforation were assessed by standing plain abdominal radiograph (SPAR) and ultrasound scan (US). Patients who had a normal SPAR, and showed free or viscous fluid in the abdomen on US underwent computed tomography (CT) scanning. Surgery was performed if patients displayed free air in the abdomen on a SPAR or CT scan, showed viscous fluid without any additional injury, provided normal radiological images but displayed signs of peritonitis, or were clinically unstable. The patients were scored according to the Injury Severity Score (ISS) system.


RESULTS
In total, 96 patients, with an average age of 10.3 ± 4 years (1-17 years) and diagnosed with a GI perforation, were reviewed retrospectively. The patients included 88 (91 %) males and 8 (9 %) females. The presence of free air on SPAR was detected in 42 (52 %) patients, whereas no free air was detected in 39 (48 %) patients. Non-specific significant findings were detected in 45 (76 %) out of 59 patients by USS, and in 78 % of patients by CT (viscous fluid, fluid, free air). The most affected organ was the ileum, which was detected in 37 (39 %) patients. Primary repair was performed on 71 (74 %) patients, while resection was performed on 22 (23 %); 3 (3 %) patients underwent an ostomy. Ten (10 %) patients experienced complications and five (5 %) patients died. The ISS scores for blunt and penetrating traumas were 14, 15 and no significant difference was detected between the scores (p > 0.05).


CONCLUSIONS
Although the complication rate for patients with penetrating trauma was higher than for those with blunt trauma, the rate of mortality increased in patients with blunt trauma. Free air may not be detected by SPAR even if a GI perforation exists. Since diagnostic challenges may increase the rate of mortality and morbidity in GI perforations, we believe that a combination of radiological imaging and rapid abdominal examination is important in cases where SPAR cannot detect free air.
Department of Pediatric Surgery, Medical Faculty of Dicle University, Diyarbakir, AZ, 21000, Turkey. drserkanarslan@hotmail.com.|Dicle Üniversitesi Tıp Fakültesi, Çocuk Cerrahi A.D., Diyarbakır, Turkey. drserkanarslan@hotmail.com.
Serkan
S
Arslan
Department of Pediatric Surgery, Medical Faculty of Dicle University, Diyarbakir, AZ, 21000, Turkey.
Mehmet Hanifi
MH
Okur
Department of Pediatric Surgery, Medical Faculty of Dicle University, Diyarbakir, AZ, 21000, Turkey.
Mehmet Serif
MS
Arslan
Department of Pediatric Surgery, Medical Faculty of Dicle University, Diyarbakir, AZ, 21000, Turkey.
Bahattin
B
Aydogdu
Department of Pediatric Surgery, Medical Faculty of Dicle University, Diyarbakir, AZ, 21000, Turkey.
Hikmet
H
Zeytun
Department of Pediatric Surgery, Medical Faculty of Dicle University, Diyarbakir, AZ, 21000, Turkey.
Erol
E
Basuguy
Department of Emergency Medicine, Medical Faculty of Dicle University, Diyarbakir, AZ, 21000, Turkey.
Mustafa
M
Icer
Department of Radiology, Medical Faculty of Dicle University, Diyarbakir, AZ, 21000, Turkey.
Cemil
C
Goya
D000007:Abdominal Injuries / Q000000981:diagnostic imaging / Q000601:surgery*; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D014463:Ultrasonography; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D014950:Wounds, Penetrating / Q000000981:diagnostic imaging / Q000601:surgery*
Blunt; Children; Gastrointestinal; Penetrating; Perforation; Trauma
South Med J. 1984 Sep;77(9):1075-7
6484670
J Trauma. 1984 Nov;24(11):978-82
6502771
Niger J Clin Pract. 2008 Sep;11(3):250-3
19140363
J Am Osteopath Assoc. 2000 Aug;100(8):496-7
10979255
World J Emerg Surg. 2007 Jun 04;2:14
17547770
Br J Surg. 2001 Jul;88(7):901-12
11442520
Oman Med J. 2009 Oct;24(4):256-9
22216378
J Pediatr Surg. 1989 Jun;24(6):580-3
2738826
J Trauma. 1974 Mar;14(3):187-96
4814394
J Trauma. 2010 Apr;68(4):790-5
20386275
Surg Today. 2003;33(3):178-82
12658382
Pediatr Radiol. 1996;26(3):188-94
8599006
J Trauma. 1996 Jul;41(1):110-3
8676401
Gac Med Mex. 2000 Nov-Dec;136(6):547-53
11131856
Crit Ultrasound J. 2013 Jul 15;5 Suppl 1:S4
23902744
Am Surg. 1980 Feb;46(2):100-4
7369626
AJR Am J Roentgenol. 1989 Sep;153(3):561-4
2763956