Significance of bowel wall enhancement on CT following blunt abdominal trauma in childhood.

Over a 3-year period, 12 children with blunt abdominal trauma were noted to have intense bowel wall enhancement (BWE) on CT. In four, with fatal CNS injury, there was no evidence of bowel perforation, and the changes may be related to the hypovolemic complex. In the remaining eight patients with a gastrointestinal perforation, BWE was associated with the presence of diffuse or focal bowel wall thickening and free peritoneal fluid. The enhancement and thickening were due to peritonitis secondary to perforation as shown at operation or autopsy. In three further patients with bowel perforation, thickening and enhancement were absent in two with retroperitoneal perforation and thickening, and no enhancement was noted in one patient in whom the study was considered suboptimal in retrospect. Intense BWE, therefore, aids in the diagnosis of the hypovolemic complex: CNS injury and bowel perforation. When combined with bowel thickening and free fluid, perforation and peritonitis should be strongly suggested. Enhancement and thickening should suggest perforation even if other visceral injury is present to account for the free fluid. Surgical intervention should thus be more strongly considered when bowel wall thickening accompanies BWE.