Oral contrast with computed tomography in the evaluation of blunt abdominal trauma in children

• Published in: British journal of surgery Vol. 86; no. 8; pp. 1073 - 1077
• Main Authors: Shankar, K. R., Lloyd, D. A., Kitteringham, L., Carty, H. M. L.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Science Ltd 01-08-1999; Wiley
• Subjects: Abdomen; Abdominal Injuries - diagnostic imaging; Administration, Oral; Adolescent; Biological and medical sciences; Child; Child, Preschool; Contrast Media - administration & dosage; Female; Humans; Infant; Injuries of the abdomen. Foreign bodies of the digestive system; Intestines - injuries; Kidney - injuries; Liver - injuries; Male; Medical sciences; Retrospective Studies; Spleen - injuries; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Tomography, X-Ray Computed - methods; Traumas. Diseases due to physical agents; Wounds, Nonpenetrating - diagnostic imaging; Human; Abdominal disease; Oral administration; Radiologic investigation; Blunt body; Diagnosis; Reliability; Child; Trauma; Contrast media; Abdomen
• ISSN: 0007-1323; 1365-2168
• DOI: 10.1046/j.1365-2168.1999.01192.x

Background:
The use of oral contrast in evaluating children by computed tomography (CT) following blunt trauma is controversial. The aim of this study was to evaluate retrospectively the use of oral contrast with abdominal CT in children with suspected abdominal injury.
Methods:
The medical records of 101 children who underwent CT for abdominal trauma between 1993 and 1997 were reviewed for data pertaining to the mechanism of injury, clinical findings and management. Scans were reviewed by a paediatric radiologist and criteria of intestinal injury on CT described by Cox and Kuhn were used: (1) extraluminal air or contrast material, (2) focal area of thickening of bowel wall and mesentery, and (3) free intraperitoneal fluid in the absence of solid organ injury.
Results:
CT was performed within a median time of 2·4 (range 1–48) h after the injury. On 37 (62 per cent) of 60 scans in children who had oral contrast, the duodenum was not opacified after a mean delay of 30 min. Intestinal injury was suspected on CT in four children. In two children with CT evidence of intestinal injury (with/without oral contrast) rupture of the duodenojejunal flexure (n = 1) or ileal perforation (n = 1) was found at laparotomy. Two children had a false‐positive scan, leading to negative laparotomy; one scan with oral contrast incorrectly suggested a duodenal leak and in another child CT without oral contrast showed thickening of bowel wall with free intraperitoneal fluid but no specific intestinal injury was identified at laparotomy. One patient had two negative CT scans (with and without oral contrast) and underwent laparotomy for clinical suspicion of bowel injury; rupture of the splenic flexure of the colon was found at laparotomy.
Conclusion:
CT is not reliable for diagnosing intestinal injuries and this is not improved by use of oral contrast. Omission of oral contrast was not associated with delay in the diagnosis of intestinal injury. Since intestinal injuries are uncommon in children, a prospective multicentre study would determine more precisely the role of the routine use of oral contrast. © 1999 British Journal of Surgery Society Ltd