Early surgical intervention for blunt bowel injury

McNutt, Michelle K.; Chinapuvvula, Naga Ramesh; Beckmann, Nicholas M.; Camp, Elizabeth A.; Pommerening, Matthew J.; Laney, Rece W.; West, O. Clark; Gill, Brijesh S.; Kozar, Rosemary A.; Cotton, Bryan A.; Wade, Charles E.; Adams, Phillip R.; Holcomb, John B.

doi:10.1097/ta.0000000000000471

Cited by 77 publications

(99 citation statements)

References 25 publications

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“…Surgeons should make a comprehensive assessment that combines physical examination, laboratory, and radiographic findings to diagnose bowel injuries. McNutt et al [33] demonstrated that diagnostic accuracy for bowel injury becomes efficient via scoring using the Bowel Injury Prediction Score (BIPS). The BIPS includes physical examination, presence of leukocytosis, and CT findings.…”

Section: Discussionmentioning

confidence: 99%

Early diagnosis of hollow viscus injury using intestinal fatty acid–binding protein in blunt trauma patients

Matsumoto

Sekine

Funaoka³

et al. 2017

Medicine

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A delay in diagnosing hollow viscus injury (HVI) causes an increase in mortality and morbidity. HVI remains a challenge to diagnose, and there is no specific diagnostic biomarker for HVI. We evaluated the utility of intestinal fatty acid–binding protein (I-FABP) in diagnosing HVI in blunt trauma patients. Within a 5-year period, 93 consecutive patients with clinically suspected HVI at our trauma center were prospectively enrolled. The diagnostic performance of I-FABP for HVI was compared with that of other various parameters (physical, laboratory, and radiographic findings). HVI was diagnosed in 13 patients (14%), and non-HVI was diagnosed in 80 patients (86%). The level of I-FABP was significantly higher in patients with HVI than in those with non-HVI (P = 0.014; area under the curve, 0.71). The sensitivity, specificity, positive predictive value, and negative predictive value were 76.9%, 70.0%, 29.4%, and 94.9%, respectively (P = 0.003). However, all other biomarkers were not significantly different between the groups. Presence of extraluminal air, bowel wall thickening on computed tomography (CT), and peritonitis signs were significantly higher in patients with HVI (P < 0.05). Of 49 patients (52.7%) who had a negative I-FABP and negative peritonitis signs, none developed HVI (sensitivity, 100%; negative predictive value, 100%). This is the first study that demonstrated the diagnostic value of a biomarker for HVI. I-FABP has a higher negative predictive value compared to traditional diagnostic tests. Although the accuracy of I-FABP alone was insufficient, the combination of I-FABP and other findings can enhance diagnostic ability.

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Section: Discussionmentioning

confidence: 99%

Early diagnosis of hollow viscus injury using intestinal fatty acid–binding protein in blunt trauma patients

Matsumoto

Sekine

Funaoka³

et al. 2017

Medicine

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“…The decisions with regard to management should be based on the combination of the results of physical examination, the presence of leukocytosis, and multidetector CT findings. The presence of leukocytosis, triangular mesenteric collections of fluid, or fluid in multiple locations is suggestive of occult bowel injury and mandates surgical exploration (14,15). A small amount of lowattenuation pelvic fluid is more reassuring.…”

Section: Invited Commentary On "Multidetector Ct Of Surgically Provenmentioning

confidence: 99%

Invited Commentary on “Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury”

Patlas

2017

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“…These lesions occur as a result of high energy trauma involving motor vehicle accidents in 70-90% of cases. [2][3][4][5][6][7][8][9] The most common cause of HVI in our study is RTA (70%) and most of the patients were young and there is a need to focus on the preventive aspects also.…”

Section: -5mentioning

confidence: 99%

“…1 Hollow viscus and mesenteric injury are found in 3-5% of patients treated for blunt abdominal trauma (BAT). [2][3][4][5] They represent 16% of all lesions seen in BAT and in third in order of frequency after liver and splenic injury. Hollow viscus injury (HVI) is difficult to diagnose and any delay in diagnosis will eventually increase the morbidity and mortality.…”

Section: Introductionmentioning

confidence: 99%

Hollow viscus injury due to blunt abdominal trauma

et al. 2017

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Background: Management of hollow viscus injury (HVI) due to blunt abdominal trauma (BAT) is a challenge to the clinicians even in the era of advanced imaging and enhanced critical care. Repeated clinical examination with appropriate imaging with multidisciplinary teamwork is the key for timely intervention in equivocal cases for successful outcomes. Aim of the study was to present our experience over last 4½ years.Methods: This is a retrospective study of prospectively collected data of patients treated at surgical gastroenterology department, Nizam’s Institute of Medical Sciences, Hyderabad, India over a period of 4½ years (2012-2016).Results: A total of 126 BAT Patients were treated in our unit as inpatients during the last 4½ years. Out of 126, twenty patients (15.87%) with HVI in whom surgical intervention was done formed the study group. Contrast enhanced CT Scan abdomen and chest was done in stable patients (13/20), in rest of the patients (7/20) the decision to operate was taken more on clinical grounds along with X-ray abdomen and USG abdomen features. 12 (60%) had jejunal and ileal injuries, 5 (25%) patients had colonic injuries (sigmoid 4, caecum 1). One (5%) patient had extra peritoneal rectal perforation with ascending retroperitoneal fascitis and 2 (10%) had duodenal injury. Two (10%)patients required relaparotomy. We had mortality in 3 (15%) patients and 17 (85%) patients had complete recovery.Conclusions: Hollow viscus injury should be suspected in all cases of blunt abdominal trauma. In equivocal cases careful repeat clinical examinations with close monitoring and repeat imaging is highly essential to prevent delay in intervention. Type of procedure is based on time of presentation, degree of contamination, associated injuries and general condition of the patient.

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Early surgical intervention for blunt bowel injury

Abstract: Prognostic study, level III.

Cited by 77 publications

References 25 publications

Early diagnosis of hollow viscus injury using intestinal fatty acid–binding protein in blunt trauma patients

Early diagnosis of hollow viscus injury using intestinal fatty acid–binding protein in blunt trauma patients

Invited Commentary on “Multidetector CT of Surgically Proven Blunt Bowel and Mesenteric Injury”

Hollow viscus injury due to blunt abdominal trauma

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