Trauma is the leading cause of mortality between 1 and 18 years of age. 1,2 Although blunt abdominal trauma is common in childhood, small bowel injury (SBI) is infrequent with an incidence of between 1 and 7% in most series. 3–10 However, there is evidence that the incidence of this injury is increasing, perhaps as a result of legislative changes requiring the use of passenger restraints and the design of the lap-only belt. 11–13 The presentation of SBI may be delayed and the initial physical findings deceptive. 5,8–10 Despite radiological imaging including ultrasound (US) or computed tomography (CT) scan with contrast, the diagnosis is often not made until peritonitis occurs. 4,6–10 The significance of this diagnostic delay in children is uncertain, with most series reporting few adverse sequelae and no deaths. 3,5,6,9,10 The purpose of this review was to determine the incidence of SBI in an Australian setting where there is predominantly blunt rather than penetrating trauma, and to report our experi- ence in the diagnosis and management of these injuries. METHODS A retrospective review was performed of the paediatric trauma registry that has been maintained from January 1988 at Westmead Hospital and subsequent to 1995 at The New Children’s Hospital (NCH), created after the merger of The Royal Alexandra Hospital for Children and paediatric services at Westmead Hospital. These data were collected prospectively by the trauma research nurse and maintained using Clinical Reporting Software (CRS) database software. Patients with SBI were identified on the basis of their injury severity score (ISS). 14 Patients coded correctly with SBI at the Royal Alexandra Hospital for Children, Camperdown, between January 1988 and November 1999 were also included. These patients were identified by searching the medical records database using ICD9, 9CM and 10 codes. The case notes and radiological investigations were reviewed and data collected on the mechanism of injury, diagnostic and operative interventions, adverse sequelae and outcome. RESULTS A total of 28 patients were identified with SBI over the 11-year and 11-month period of review. There were 14 male and 14 female patients, with an age range of 9 months to 15 years. Fifteen children came from outside the metropolitan area, accounting for 54% of the cases in total and all but one of the subsequent five deaths. The most common injuries were mesenteric contusions and jejunal perforations, which together accounted for 14 (50%) of the total number of patients (Table 1). Duodenal perforation, avulsion of the jejunum at the duodenal-jejunal (D-J) flexure, ileal perforation and evisceration of the small bowel were uncommon, accounting for one or two cases each. A motor vehicle accident (MVA) was the cause in 20 (71%) of the cases: the remaining injuries occurred following non- accidental Injury (NAI) in seven and a bicycle accident in one. Whilst the use of lap-only safety belts was associated with five MVA, SBI occurred in nine cases who were wearing a lap-sash safety belt. One 12-month-old child was in a forward-facing child restraint, and in three cases no form of restraint was used. J. Paediatr. Child Health (2000) 36, 265–269 Small bowel injuries in children AJA HOLLAND, 1 DT CASS, 1,2 MJ GLASSON 2 and J PITKIN 2 1 Department of Surgical Research and 2 Douglas Cohen Department of Paediatric Surgery, The New Children’s Hospital, Royal Alexandra Hospital for Children, Westmead, New South Wales, Australia Objective: To determine the common features of small bowel injury (SBI) in childhood and the consequences of delayed diagnosis. Methodology: A retrospective case review was performed of children with traumatic SBI between January 1988 and November 1999. Results: Twenty-eight patients were identified with SBI. Road trauma accounted for 71% of them. Tachycardia was present on admission in 82% of patients with SBI including all but one of the intestinal perforations. SBI was associated with a Chance fracture of the lumbar spine in three patients (11%). An abdominal computed tomography scan with intra- venous contrast was abnormal in all patients with a perforation or mesenteric tear. Diagnosis was delayed in six patients, one of whom died as a result of sepsis from a small bowel perforation. Conclusions: Persistent tachycardia with an appropriate mechanism of injury following blunt abdominal trauma requires active exclusion of SBI. Delayed diagnosis is associated with significant morbidity and mortality. Key words: computed tomography scan; diagnosis; small bowel injury. Correspondence: Professor DT Cass, Department of Surgical Research, The New Children’s Hospital, Royal Alexandra Hospital for Children, PO Box 3515, Parramatta, New South Wales 2124, Australia, Fax: (02) 9845 3180; email: DannyC@nch.edu.au AJA Holland, BSc, FRCS, FRACS. Sir Roy McCaughey Surgical Research Fellow. DT Cass, PhD, FRCS, FRACS. William Dunlop, Professor of Paediatric Surgery. MJ Glasson, FRCS, FRACS, Consul- tant Paediatric Surgeon and Head of Department. J Pitkin, FRCS, FRACS, Visiting Consultant Paediatric Surgeon. Accepted for publication 18 January 2000.