Evaluation of intestinal injuries from blunt abdominal trauma

Abstract

Background: To Evaluate the cause, presentation, anatomical extent, diagnostic method, management and outcome of intestinal injuries from blunt abdominal injuries.Methods: The study included 40 patients who underwent laparotomy for intestinal injuries from blunt abdominal trauma over a period of 1 year. A retrospective study was conducted, and the patients were evaluated with respect to the cause, presentation, anatomical distribution, diagnostic methods, associated injuries, treatment and mortality.Results: 40 patients with 58 major injuries to the bowel and mesentery due to blunt abdominal trauma were reviewed. The male to female ratio was 9: 1 and the average age was 32.51 years. There were 38 injuries to the small intestine including 1 duodenal injury, 13 colonic injuries and 6 isolated injuries to the mesentery. Out of 29 patients with intestinal perforation, free peritoneal air was present on plain abdominal and chest radiography in 23 patients. The commonest injury was a perforation at the antimesenteric border of the small bowel. Treatment consisted of laparotomy followed by simple closure of the perforation, resection and anastomosis and repair followed by protective colostomy for colonic perforations. 3 (7.56%) deaths were recorded, while 6 (15%) patients developed major complications.Conclusions: Bowel and mesenteric injuries may be significant and require immediate surgery or may be nonsignificant and permit nonsurgical treatment. Although early recognition of intestinal injuries from blunt abdominal trauma is difficult only by clinical assessment, nevertheless important to establish the right diagnosis due to its high infective potential. Intestinal perforations are often found accompanying other severe intra-peritoneal injuries which probably, are the determining factors in morbidity and mortality hence the main emphasis lying on early detection of the injuries and reducing the time from admission to the surgery thus playing a role in the reduction of mortality and morbidity associated with intestinal injuries following blunt trauma abdomen.