Pediatric Bowel Trauma

  • Etiology: blunt abdominal trauma
  • Imaging:
    — CT with IV contrast and +/- oral contrast is study of choice
    — see moderate volume free intraperitoneal fluid or hemoperitoneum with unexplained source and no solid organ injury, focal / multifocal bowel wall thickening and enhancement – small bowel most common, focal bowel wall thickening with adjacent fluid present which should raise suspicion for sealed perforation, localized large intramural hematoma – duodenum most common, mesenteric edema / contusion, fluid at mesenteric root, pneumoperitoneum, pneumoretroperitoneum from duodenal injury, extravasation of oral contrast, focal bowel wall defect, active hemorrhage, mesenteric pseudoaneurysm
    — if initial CT is negative and abdominal pain persists, repeat CT at 24 hours to look for increasing amount of free intraperitoneal fluid
  • Note: pitfall is mesenteric laceration can result in free fluid
  • Treatment: injuries often requiring surgical intervention – full thickness bowel injury: moderate volume peritoneal fluid or hemoperitoneum with unclear source and no solid organ injury, pneumoperitoneum, pneumoretroperitoneum, focal bowel wall defect, extravasated oral contrast, active hemorrhage, mesenteric pseudoaneurysm
  • Clinical: in 1-3% of patients, commonly associated with lap belt ecchymoses and handlebar injuries

Radiology Cases of Bowel Trauma

CT of bowl trauma / bowel perforation
Initial axial CT with contrast of the abdomen (left images) shows no solid organ injury but a moderate amount of free fluid in the abdomen and pelvis. Repeat axial CT with contrast of the abdomen obtain a day later due to increasing abdominal pain (right images) shows a marked increase in the free fluid within the abdomen and pelvis.

Surgery Cases of Bowel Trauma

Surgical image of small bowel perforation
Surgical image shows an ileal perforation with the forceps placed through the perforation.