Pediatric Duodenal Perforation Missed on Computed Tomography, ,

We present the case of a 2-year-old child who sustained duodenal perforation after blunt abdominal trauma. The presentation of gastrointestinal perforation after blunt abdominal trauma in children can be subtle and at times delayed. A slight increase in the concentration of aspartate aminotransferase, alanine aminotransferase, or pancreatic enzymes may be the only indication of hollow viscus injury. Initial radiographic studies have a low yield in detecting such injuries. Computed tomography is also unreliable. Conservative management with serial examinations and serial laboratory studies may be required to identify gastrointestinal perforation. [Barandica R, Patel M: Pediatric duodenal perforation missed on computed tomography. Ann Emerg Med October 1997;30:545-547.]