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Pulmonary Artery Aneurysm
Joseph Junewick, MD FACR
over 7 years ago
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Gatric Rupture

Case Detail

Anatomy: Gastrointestinal
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 6 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: CT
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History

Teenage snowboarder who mislanded jump.


Case Images


Diagnosis

Gastric Rupture

Findings

CT – Coronal image demonstrates focal thickening of the cardia. Axial images demonstrate frothy contents in the left upper quadrant and small amount of free air. Patient also had splenic and left renal lacerations.

Discussion

Bowel injury is uncommon after blunt trauma in children. Injury can result in a partial-thickness injury or a full-thickness injury that results in bowel rupture. Associated mesenteric injury is often present. Most injuries are noted in children who have been involved in motor vehicle crashes. Clinical signs and symptoms may be absent, minimal, or delayed.

Intramural hematoma results from hemorrhage into the bowel wall after a partial-thickness tear. The most common location is the duodenum. The injury can usually be managed nonoperatively. Large hematomas can result in a proximal small-bowel obstruction. The CT appearance is of focal bowel wall thickening that is often eccentric. Neither extraluminal air nor extravasated contrast material should be present.

Bowel rupture most commonly occurs in the mid to distal small intestine. The most common site is the jejunum. Extraluminal air is noted in only approximately one third to one half of cases; extravasation of oral contrast material is rarely seen. The most frequent CT finding associated with bowel rupture is peritoneal fluid in the absence of solid viscus injury or pelvic fracture. Additional CT findings associated with bowel rupture include abnormally intense bowel wall enhancement, focal bowel wall discontinuity, bowel dilatation, bowel wall thickening, and streaky infiltration of mesenteric fat.

Reference

Sivit CJ. Imaging children with abdominal trauma. AJR (2009);192:1179-1189.



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