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Surgical Management of Traumatic Bowel Injuries in the Pediatric Population: Experience Over 7 Years
Simone Langness, MD1, R. Lizardo2, K Davenport3, T. Fairbanks3 and J. Grabowski4; 1University of California, San Diego CA; 2Navy Medical Center, San Diego CA; 3Rady Children's Hospital, San Diego CA; 4Lurie Children's Hospital, Chicago IL

Abstract:
Introduction: Bowel injuries (BI) are rare and varied with respect to severity and mechanism. Imaging limitations and subtle, non-specific symptoms at presentation may lead to delay in diagnosis. Given the heterogeneity of BI, surgical management is diverse and incompletely described. We sought to review injury mechanism, surgical management and outcomes from a series of pediatric patients with BI. Methods: We reviewed patients 6 hours from admission). Reasons for delay included management of concurrent injuries (27%), resuscitative efforts (9%) and delay in diagnosis (73%). In comparing the DOI group to the immediate operative group, there were no significant differences in length of stay (12.6 vs. 19.1 days, p=0.46), time to full feeds (8.2 vs. 9.8 days, p=0.58) and stoma formation (0 vs. 5, p=0.31). Discussion: BI can be managed safely with primary repair or segmental resection in the majority of cases. The need for complex repairs such as stoma formation or temporary abdominal closure increases with severity of mechanism and is unchanged regardless of timing of surgery.
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Objective Content:
Isolated bowel injuries can occur following penetrating and blunt abdominal trauma. In blunt abdominal trauma, risk is highest for bowel injuries in settings in which energy is transferred to a discrete and limited area of the abdomen, such as with seatbelt injuries in motor vehicle collision, direct blows to the abdomen in non-accidental trauma and with bicycle handlebar injuries.


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