[Traumatic perforation of the small intestine in childhood]. / Perforación traumática del intestino delgado en la infancia.

INTRODUCTION: Traumatic perforation of the small bowel occurs in approximately 1 percent of children with either blunt or penetrating trauma to the abdomen. Difficulty in recognition of initial subtle signs of hollow viscus injury can lead to delay in both diagnosis and operative intervention. MATERIAL AND METHOD: Medical records for patients discharged with traumatic small bowel perforation from the General Surgery Department between 1991 and 1999 were reviewed. RESULTS: Bowel injuries were noted in 41 children. Blunt trauma (battered child syndrome, bike injuries, etc.), was responsible for 37 cases and penetrating wounds in three (firearm wounds and bike pedal accidents). There were 32 boys and a mean age of 6.8 years. The site of perforation was duodenal in four cases, jejunum in 21, and ileum in sixteen. Associated injuries occurred in 11 patients, including stomach, pancreas, liver, spleen, bladder, and ureter. Twenty-nine had simple closure, while seven were resected. Four children died. CONCLUSIONS: These injuries require prompt surgical intervention and are in general curable with excellent prognosis if one is alert to the possibility of their occurrence, if one is familiar with the approaches to prompt and accurate diagnosis, and if associated injuries are not serious.

[Interstitial gastric emphysema in children]. / Enfisema gástrico intersticial en niños.

UNLABELLED: Gastric pneumatosis is an unusual clinical finding in infants and children and it appears in the three following similar conditions: pneumatosis cystoides; emphysematous gastritis, and gastric emphysema. MATERIALS METHODS AND RESULTS: The clinical pictures and radiographic appearance of this association are described in four patients in whom the clinical course made suspect interstitial gastric emphysema. Two patients had hypertrophic pyloric stenosis and two, unspecific erosive gastritis. In the first two patients, a Fredet-Ramstedt procedure was performed. All patients survived. Differential diagnostic considerations, the importance of correct radiological diagnosis, and the results of proper therapy are discussed. CONCLUSIONS: Pyloric and duodenal obstruction in infants is the main etiologic factor in gastric emphysema.