The value of CT in detecting bowel perforation in children after blunt abdominal trauma

Abstract

When free air is not present, secondary signs of bowel wall thickening and unexplained peritoneal fluid suggest a bowel perforation.

The Role of Abdominal CT in Determining Perforation Findings and Site in Patients with Gastrointestinal Tract Perforation.

“…Fakat bazı yazarlar paralitik ileusu olan hastalarda kontrast maddenin yavaş ilerlemesi nedeni ile oral kontrast kullanımını tercih etmezler. [23,24] Oral kontrast peritoneal sıvının miktarını artırarak sepsis riskini artırabilir diyen görüşler de vardır. [25] Ekstraluminal kontrast madde varlığı tanı değe-ri yüksek bir bulgu olmakla birlikte görülme sıklığı %19-42 gibi düşük değerlerdedir.…”

Oral Contrast Solution and Computed Tomography for Blunt Abdominal Trauma

“…4,9,12,13,15 In addition, there are pediatric and adult trauma centers where OC is not routinely used as part of the blunt abdominal CT scan protocol. 15,17,18 The rationale for the use of OC in trauma CT of the abdomen is well delineated in the literature. One of the most commonly cited diagnostic signs of bowel perforation is the extravasation of OC.…”

“…10 Small perforations may seal quickly and prevent extravasation of contrast and/or air that could then be detected by CT scan. 10,18 The sensitivity of CT scan with OC for the diagnosis of blunt bowel injury ranges from 80% and 100% depending on the criteria used. 14,19,21 Kearney et al 14 reported a sensitivity of only 80% for detection of bowel injury by CT scan with OC, while Sherck et al 19 reported a sensitivity of 92%.…”

“…In a center where OC is not used in the protocol for blunt abdominal trauma CT scans, 6 patients with small-bowel injury at laparotomy all had findings on CT that were suggestive of bowel injury and 2 of these only had bowel wall thickening and free peritoneal fluid. 18 Other investigators have determined that OC was unnecessary for the diagnosis of small-bowel injury. 13,15 In those patients who had bowel injury at laparotomy, we identified 6 of 7 patients in the OC group (sensitivity 86%) and 100% in the no OC group by using the presence of free fluid not explained by solid organ injury and/or thickened bowel wall in addition to pneumoperitoneum and contrast extravasation as criteria for bowel injury.…”

Sonographic Detection of Small Amounts of Free Peritoneal Gas in Beagle Dogs

“…However, differentiation of intra-peritoneal air from fat or intra-luminal air may be difficult if the window widths and levels are not appropriately altered [3]. Additionally, the use of CT scanning for the detection of pneumoperitoneum in animals has generally been restricted by limited availability and the need for general anesthesia [2].…”