Pediatric Bowel Trauma

  • Etiology: blunt abdominal trauma
  • Imaging: best signs are unexplained free fluid / focal bowel wall thickening and enhancement / focal bowel wall thickening with adjacent fluid present which should raise suspicion for sealed perforation, extraluminal gas is rare in anterior abdomen (pneumoperitoneum) / porta hepatis / mesentery / retroperitoneum (pneumoretroperitoneum) from duodenal injury, mesenteric fluid, mesenteric IV contrast extravasation due to active hemorrhage, extravasation of oral contrast, bowel discontinuity
  • Clinical: in 1-3% of patients, commonly associated with lap belt ecchymoses and handlebar injuries
  • Note: pitfall is mesenteric laceration can result in free fluid

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.