![]() Duodenal hematoma, perforation, and transection have been documented.Hollow Organs (12% of hospitalizations).Abuse is reported as being the 2nd or 3rd most common cause of hepatic injury in children, after MVCs.Liver injury is the most commonly seen in hospitalized patients (64%).All abdominal organs are at risk for injury.The liver and spleen are, thus, more anterior and less protected by rib cage.The diaphragm is more horizontal compared to older patients.That transmitted force now is absorbed by the underlying organs and structures.The compliant ribs do not dissipate force.Thinner abdominal muscles and less fat.Anatomic features that make children more susceptible to blunt abdominal trauma:.Let’s digest a quick ( and delicious) morsel on Duodenal Hematoma in Children: One of those history features is the classic bike injury sustained when the bike handlebar strikes the upper abdomen. Sometimes, the history alone is enough to raise a red flag. Additionally, signs of trauma can be minimal or nonexistent. The child’s abdominal wall, unfortunately, is not as protective of the internal structures compared to adults’ abdominal wall. ![]() doi:10.1097/TA.Abdominal trauma in children should garner an appropriate amount of respect and concern. Missed injuries in the era of the trauma scan. Lawson CM, Daley BJ, Ormsby CB, Enderson B. Radiographics : a review publication of the Radiological Society of North America, Inc. Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury. Bates DD, Wasserman M, Malek A, Gorantla V, Anderson SW, Soto JA, LeBedis CA. Seatbelt sign following blunt trauma is associated with increased incidence of abdominal injury. Available from: American Society of Colon and Rectal Surgeons Evaluation of bowel and mesenteric blunt trauma with multidetector CT. Brofman N, Atri M, Hanson JM, Grinblat L, Chughtai T, Brenneman F. Read it at Google Books - Find it at Amazon doi:10.1007/s1226-4 - Free text at pubmed - Pubmed citation Multi Detector Computed Tomography in the Diagnosis of Bowel Injury. Performance of CT in detection of bowel injury. Abdominal CT findings in small bowel perforation. Emergency Radiology: Imaging and Intervention. Mesenteric infilatration: haziness and fat stranding Intermesenteric free fluid, often forming triangles 7īeading and termination of mesenteric vessels 4, 7Ībrupt termination of the mesenteric vessels 7Īccumulation ('pooling') of contrast on multiphase imaging Positive seatbelt sign increases the likelihood of traumatic bowel injuries 9Īctive extravasation of contrast media is indicative of active bleeding and a significant mesenteric injury 3 Moderate/large volume of free fluid without solid organ injury 2-3Ībnormal bowel wall enhancement: decreased due to mesenteric vascular interruption and small bowel ischemia, or increased due to vascular permeability secondary to hypoperfusion 7 Mural hematoma: discontinuity in the bowel wall with mural thickening (>3-4 mm) may be complete (i.e. In penetrating trauma, extra-luminal free gas is not specific to bowel perforation extra-luminal contrast media/bowel contents leak and a wound track extending to bowel is considered the most sensitive wall thickening/mesenteric contusion is less sensitive 2 In blunt trauma, the presence of extra-luminal oral contrast media (if used) or bowel contents extra-luminal free gas (especially in the absence of pneumothorax/ pneumomediastinum) 2 The mechanism of bowel injury include crush/compression type, shearing type (from fixed point of mesentery) and burst type (from increased intra-luminal pressure) and can include 4: Jejunum (near ligament of Treitz/D-J flexure)Ĭolon ( cecum, transverse colon, sigmoid colon) Typesįrom most to least common sites of bowel injury 1,4,6: Motor vehicle collisions are the most common cause of blunt trauma followed by falls, assaults and sports-related trauma 4,6. Gunshot wounds (~75%) and stabbings (~20%) are the leading causes of bowel and mesenteric injury from penetrating trauma 8. Bowel injury has consistently been found to be the most common traumatic abdominopelvic injury missed on CT 11. However not surprisingly, bowel and mesenteric injuries are more frequent after penetrating trauma 8. The bowel and mesentery are injured in ~2.5% (range 0.3-5%) of blunt force abdominal trauma 1,3,5,8.
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