Slovenská chirurgia 3 - 4/2021

Diagnosing of small bowel injury in pediatric handlebar injury using CT defined findings

Bicycle accidents are a significant cause of traumatic morbidity in the pediatric population. These accidents should be considered as potentially producing serious intraabdominal injury. CT examination is at the moment considered as the standard examination to delineate intra-abdominal trauma with a reported high sensitivity and specificity. Small intestinal lesions without the presence of pneumoperitoneum are problematic to diagnose. Free intraperitoneal air and focal bowel wall thickening are associated with strong likelihood of bowel injury requiring surgical repair and are good detectable. MDCT detailed examination of anatomical sub-structures of organs is able to reveal structural injury of the mucosa and internal parts of the bowel wall, even when there is not complete disruption of bowel continuity. We describe findings which should help to diagnose partial bowel lesions. Local hyperdense spheric lesion, disintegration of the bowel mucosa and luminal obstruction of the small bowel should be considered as signs also confirming small intestine lesions. Moreover, concomitant MDCT and ultrasound examination can help to differentiate inconclusive CT findings and it can also point to a suspicious area, which should be examined more closely.

Keywords: bowel injury, MDCT, handlebar injury, sub-structure examination, combination CT with ultrasonography investigation