Hollow viscus injuries: predictors of outcome and role of diagnostic delay

Abstract

IntroductionHollow viscus injuries (HVIs) are uncommon but potentially catastrophic conditions with high mortality and morbidity rates. The aim of this study was to analyze our 16-year experience with patients undergoing surgery for blunt or penetrating bowel trauma to identify prognostic factors with particular attention to the influence of diagnostic delay on outcome.MethodsFrom our multicenter trauma registry, we selected 169 consecutive patients with an HVI, enrolled from 2000 to 2016. Preoperative, intraoperative, and postoperative data were analyzed to assess determinants of mortality, morbidity, and length of stay by univariate and multivariate analysis models.ResultsOverall mortality and morbidity rates were 15.9% and 36.1%, respectively. The mean length of hospital stay was 23±7 days. Morbidity was independently related to an increase of white blood cells (P=0.01), and to delay of treatment >6 hours (P=0.033), while Injury Severity Score (ISS) (P=0.01), presence of shock (P=0.01), and a low diastolic arterial pressure registered at emergency room admission (P=0.02) significantly affected postoperative mortality.ConclusionThere is evidence that patients with clinical signs of shock, low diastolic pressure at admission, and high ISS are at increased risk of postoperative mortality. Leukocytosis and delayed treatment (>6 hours) were independent predictors of postoperative morbidity. More effort should be made to increase the preoperative detection rate of HVI and reduce the delay of treatment.

Laparoscopy for blunt abdominal trauma: a challenging endeavor

“…The question on when to offer laparoscopy and whether to engage in a trial of non-operative management still remains unanswered. The combination of radiographic, laboratory, and physical examination findings was utilized in the Bowel Injury Prediction Score (23,28). The score of 2 or greater is highly suggestive of bowel injuries and may suggest early diagnostic laparoscopy; however, it was not used in this study and needs prospective validation.…”

“…In most patients, only indirect signs of injuries can be identified, this can lead to missed injuries and delayed surgical treatment (20). A delay in surgical treatment of hollow viscus injuries in as little as 5 h may increase morbidity and mortality (21–23). Despite its limitations, CT remains standard imaging of hemodynamically stable patients with BAT (8, 24–27), and this study confirmed it.…”

Isolated jejunal perforation - hidden danger in blunt abdominal trauma

“…There is still no consensus in the literature regarding the effects of delayed surgical treatment of traumatic small intestine perforation, but it is generally accepted that morbidity and mortality is significantly lower in the case of early diagnosis and emergency surgical treatment [21,22] Mingoli and colleagues found that leukocytosis and delayed treatment (>6 hours) are independent predictors of postoperative morbidity [26].…”

Evaluation of the Viscus injury in Abdominal Trauma

“…Due to their rarity, experience with this injury is limited and no strong consensus exists in the literature regarding diagnosis and management of bowel injuries. [6,7] In penetrating trauma, early abdominal exploration is mandatory in 80% of cases and HVI diagnosis is prompt and easy. In blunt trauma, the non-operative management of solid organ injury has clearly increased the risk of delayed diagnosis and treatment of bowel lesions.…”