Small bowel injury in children after blunt abdominal trauma: Is diagnostic delay important?

Objective: To assess the incidence and consequences of small bowel injury (SEI) in children suffering blunt abdominal trauma managed with the intent to treat nonoperatively. Design: Retrospective chart review. Materials and Methods: A total of 168 consecutive hemodynamically stable children admitted to a Level I pediatric trauma center during a 24-month period. Results: Nine of 168 children (5%) sustained SBI: three underwent early (<4 hours) operation for recognized SRI (identified on computed tomographic scan); and six had delayed (36 +/- 16 hours) operation for missed SBI (not identified on computed tomographic scan), Increased temperature and heart rate, or decreased urine output at 24 hours suggested occult SBI, The hospital course was unaltered by delayed diagnosis, Fifty-seven percent of the children (95) suffered intra-abdominal injury; 10% required laparotomy for SBI (9) or solid organ injury (7); 90% (152) were discharged without laparotomy. Conclusions: SBI is uncommon in children suffering blunt abdominal trauma, The diagnosis can be made using clinical and radiographic findings, Limited diagnostic delay does not seem to affect outcome. We conclude that clinical diagnosis of SEI is safe, permits the nonoperative treatment of most blunt abdominal injuries, and reduces the risk of unnecessary laparotomy associated with alternate approaches.