+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Small-bowel and mesentery injuries in blunt trauma



Small-bowel and mesentery injuries in blunt trauma



Journal of Trauma 46(5): 920-926



Background: The purpose of this study was to identify factors that would aid in the diagnosis of small-bowel and mesentery injuries (SBMI) in blunt trauma patients. Methods: Retrospective review of 15,779 blunt trauma patients admitted to a Level I trauma center between January 1991 and December 1996. Results: A total of 5,303 patients sustained abdominal injuries, 70 of whom had more than 111 SBMI. Seventy-nine percent were victims of motor vehicle collisions. Thirty patients had isolated SBMI and 40 had associated intra-abdominal injuries. Twelve patients arrived with systolic blood pressure < 90 mm Hg, eight of whom died. Mean base deficit was -7.3 +- 6.3 in 52 patients who had arterial blood gases determined. Fifty-three of 60 patients had hematuria. Sixty-seven patients required laparotomy. Delayed exploration occurred in 15 patients who underwent initial computed tomography but had subsequent changes in physical status. Two of 20 patients had negative diagnostic peritoneal lavage on admission and were eventually explored based on abdominal computed tomographic findings and changes in physical examination. There were 15 deaths. Delay in diagnosis (>12 hours after arrival) occurred in nine patients with no deaths or significant morbidities. Mean Injury Severity Score was 29 +- 16.7: 43 +- 17 in nonsurvivors and 25 +- 14.3 in survivors (p < 0.05). Conclusion: The diagnosis of SBMI is often made in the presence of associated intra-abdominal injuries. Isolated SBMI are common, however, and special attention to the mechanism of injury, abdominal examination, presence of hematuria, and significant base deficit should raise suspicion to the possibility of SBMI. Findings on abdominal computed tomography that may suggest SBMI and should prompt further evaluation include free fluid, thickened bowel, and extraluminal air. Because delay in diagnosis does not seem to affect morbidity or mortality, dedication to observation and serial physical examinations will aid in theproper identification of elusive SBMI. Mortality, however, does appear to be related to the presence of hypotension on admission and associated injuries.

Please choose payment method:






(PDF emailed within 1 workday: $29.90)

Accession: 011369684

Download citation: RISBibTeXText

PMID: 10338413


Related references

Homicidal blunt abdominal trauma with isolated laceration of the small bowel mesentery. Zeitschrift für Rechtsmedizin. Journal of Legal Medicine 93(2): 143-146, 1984

Diagnosis and management of small bowel and mesentery injury following blunt abdominal trauma in 12 cases. Journal of the Egyptian Society of Parasitology 39(1): 23-30, 2009

Small bowel injuries in children after blunt abdominal trauma. Annals of Surgery 174(2): 238-241, 1971

Small-bowel and mesenteric injuries in blunt trauma of the abdomen. Canadian Association of Radiologists Journal 64(2): 140-147, 2013

Perforating injuries of the small bowel from blunt abdominal trauma. Annals of Emergency Medicine 12(2): 75-79, 1983

Small bowel injuries in blunt abdominal trauma--a diagnostic problem!. Swiss Surgery 5): 222-225, 1995

CT of blunt trauma to the bowel and mesentery. Seminars in Ultrasound, Ct, and Mr 16(2): 82-90, 1995

Small bowel injuries following blunt abdominal trauma. Early recognition and management. New York State Journal of Medicine 90(9): 446-449, 1990

Blunt trauma to the gastrointestinal tract: CT findings with small bowel and colon injuries. Emergency Radiology 9(3): 141-145, 2004

Blunt injury to mesentery and small bowel: CT evaluation. Radiologic Clinics of North America 41(6): 1171-1182, 2003

Blunt injury of the small intestine and mesentery--the trauma surgeon's Achilles heel?. European Journal of Emergency Medicine 3(2): 85-91, 1996

Small bowell perforation and mesentery injury after an unusual blunt abdominal trauma-Case report. International Journal of Surgery Case Reports 7c(): 51-53, 2015

Injuries of the small bowel and mesentery and retroperitoneal hematoma. Surgical Clinics of North America 52(3): 729-734, 1972

Diffuse small-bowel ischemia in hypotensive adults after blunt trauma (shock bowel): CT findings and clinical significance. Ajr. American Journal of Roentgenology 163(6): 1375-1379, 1994