Dilemma of Blunt Bowel Injury: What are the Factors Affecting Early Diagnosis and Outcomes

Abstract

Blunt bowel and mesenteric injury (BBMI) is frequently a difficult diagnosis at initial presentation. We aimed to study the predictors for early diagnosis and outcomes in patients with BBMI. Data were collected retrospectively from the database registry between January 2008 and December 2011 in the only Level I trauma unit in Qatar. Patients with BBMI were divided into Group A (surgically treated within 8 hours) and Group B (treated after 8 hours). Data were analyzed and χ2, Student's t test, and multivariate regression analysis were performed appropriately. Among 984 patients admitted with blunt abdominal trauma (BAT), 11 per cent had BBMI with mean age of 35 ± 9.5 years. Polytrauma and isolated bowel injury were identified in 53 and 42 per cent, respectively. Mean Injury Severity Score (ISS) was higher in Group A in comparison to Group B (18 ± 11 vs 13 ± 8; P = 0.02). Presence of pain and seatbelt sign ( P = 0.02) were evident in Group B. Hypotension ( P = 0.004) and hypothermia ( P = 0.01) were prominent in Group A. The rate of positive Focused Assessment Sonography for Trauma was greater in Group A ( P = 0.001). Among operative findings, bowel perforation was more frequent in Group B ( P = 0.04), whereas mesenteric full-thickness hematoma was significantly higher in Group A. Pelvic fracture was more frequent finding in Group A ( P = 0.005). The overall mortality rate was 15.6 per cent. In patients with BAT, the presence of abdominal pain, hypotension, ISS greater than 16, hypothermia, pelvic fracture, and mesenteric hematoma might help in early diagnosis of BBMI. Moreover, base deficit and mean ISS were independent predictors of mortality. Delayed operative interventions greater than 8 hours increased morbidity rate but had no significant impact on mortality.

Mortality determiners for fall from height cases

“…In addition, in blunt abdominal trauma, the association with mortality of high ISS values due to gastrointestinal system injuries has been described. [21] There have been many recent developments in radiological and laboratory evaluation methods for patients with multiple trauma, and these methods are expected to be increasingly helpful for quick decision-making and the management of patients with trauma. Based on these evaluations, scoring systems and treatment algorithms have been developed to be able to approach patients with trauma in the most appropriate way.…”

Frequency, causes and pattern of abdominal trauma: A 4-year descriptive analysis

“…Although, hollow viscous injuries after blunt trauma are rare; it remains the third most common injury in blunt abdominal trauma[ 26 ] and had a reported incidence of 1-2% of all blunt trauma cases. [ 27 28 ] Costa et al . [ 11 ] reported the incidence of small bowel injury to be 10% whereas large bowel injury was identified in 6% of abdominal trauma patients.…”

Challenges in Management of Intestinal Perforation by Blunt Abdominal Trauma (Urgent Surgery Versus Conservative Surgery)

“…The conservative treatment based on the missed injuries is gradually advanced and gives rapid positive data in progression [19,20] Moreover, the outcome of delayed diagnosis and surgery is not always very bad [21]. The rate of missed injuries after early and initial evaluation may be decreased by the use of advanced technology, and the risk of delayed diagnosis will reduced by improvements of intensive care unit [22,23] Conclusion:-It is not be possible to eliminate negative surgical exploration, but you can minimize it by selective delayed surgical intervention.…”