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Findings: Large amount of free peritoneal fluid is present and is unexplained as no solid viscus injury or pelvic fracture is noted. Intense bowel wall enhancement is noted. Extra luminal air is seen in the peritoneal cavity in the lower right abdomen. Bowel thickening is present as well.

The examination was performed following the administration of IV and oral contrast, and contrast was noted in the stomach and proximal small bowel loops up to the mid jejunum. These bowel loops were not dilated. There was no contrast noted in the distal small bowel and large bowel.

Diagnosis: Small bowel rupture.

Discussion: The CT criteria that should be included in the evaluation of small bowel rupture include peritoneal fluid, extra luminal air, abnormally intense enhancement of bowel wall, bowel thickening, and bowel dilatation. The diagnosis of bowel rupture should be considered when any one of the CT findings is present. According to the article reference below, most children with bowel rupture may have two or more of the above CT findings. Also, the best predictors of bowel rupture were found to be moderate to large amounts of unexplained fluid and bowel wall enhancement.

CT findings associated with bowel rupture can overlap with those findings associated with post traumatic shock or nonperforating gastrointestinal tract injury. However, CT findings in children with post traumatic shock that are not typically seen in those with bowel rupture include intense contrast enhancement of the kidneys, abdominal aorta, and inferior vena cava and diminished caliber of the aorta and inferior vena cava. Although CT findings of perforation and nonperforating gastrointestinal tract injury overlap, the potentially serious consequences of delayed diagnosis of bowel rupture, however, justify nontherapeutic laparotomy if bowel rupture is strongly suspected.

References:
1. Blickman JG. Pediatric Radiology: The Requisites. 1994. Mosby.

2. Sivit CJ, Eichelberger MR, Tailor GA. CT in Children With Rupture of the
Bowel Caused by Blunt Trauma: Diagnostic Efficacy and Comparison with
Hypoperfusion Complex. AJR 1994; 163:1195-1198.

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