CT in children with rupture of the bowel caused by blunt trauma: diagnostic efficacy and comparison with hypoperfusion complex.

OBJECTIVE: The purpose of this study was to determine the sensitivity and specificity of CT in diagnosing bowel rupture in children after blunt trauma and to compare CT findings in children with bowel rupture with those in children with the hypoperfusion complex. SUBJECTS AND METHODS: Twenty-one (1%) of 1488 children who had contrast-enhanced CT of the abdomen after blunt trauma had a bowel rupture subsequently verified at surgery or autopsy. Thirty-three additional children had a characteristic hypoperfusion complex at CT. The CT scans in all 1488 children were prospectively evaluated for the following findings: peritoneal fluid, extraluminal air, bowel wall enhancement, bowel wall thickening, and bowel dilatation. RESULTS: The most common CT findings in children with bowel rupture were peritoneal fluid (14, 67%) and bowel wall enhancement (13, 62%). One or more of the five studied CT findings were noted in 20 of the 21 children with bowel rupture and in 64 of the 1467 children without bowel rupture (sensitivity 95%, specificity 96%). Thirty-three children who had one or more of the CT findings and did not have bowel rupture had the hypoperfusion complex. CONCLUSION: Our results show that CT is accurate in the diagnosis of bowel rupture after blunt trauma in children. The most common findings are peritoneal fluid and bowel wall enhancement. CT findings in children with bowel rupture may overlap with those in children with the hypoperfusion complex.