ECMO-/ECLS

without shoulder straps. Therefore, use of age-appropriate child restraints in
cars may decrease the risk of some of these injuries [39].
Traumatic intestinal injuries associated with perforation typically present
with signs of peritonitis due to the contamination of the peritoneal cavity. In a
neurologically intact patient, serial examinations with the development of
abdominal tenderness, guarding, and rebound have been shown to be more
specific for hollow viscus injury than abdominal US or CT findings for intestinal
injuries [40-42].^ Hemodynamically unstable patients with signs and symptoms
of hollow viscus injury should undergo emergent exploration. Although CT
scans have a lower sensitivity in detecting intestinal injuries, findings
suggestive of intestinal injury include bowel wall thickening and enhancement,
mesenteric stranding, and free intraperitoneal fluid in the absence of solid
organ injury [43].^ Current imaging modalities may miss partial thickness
intestinal injuries, hematomas, or mesenteric injuries. Over time, these injuries
may evolve or cause full thickess intestinal wall ischemia and perforation with
leakage of intestinal contents. Some mesenteric injuries may result in intestinal
strictures or internal hernia diagnosed at a time remote from after the acute
injury. A recent multi-institutional retrospective review by the APSA Trauma
Committee determined that delay in operative treatment for up to 24 hours after
injury did not significantly affect outcome [44].^
Laparoscopy should be considered an extension of the diagnostic
armamentarium in patients with equivocal imaging findings. In
hemodynamically stable patients with evidence of bowel injury, a laparoscopic