Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital

Alsayali, Mashal M.; Atkin, Christopher; Winnett, Jason; Rahim, Reza; Niggemeyer, Louise E.; Kossmann, Thomas

doi:10.1007/s00068-009-8078-4

Cited by 17 publications

(14 citation statements)

References 18 publications

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“…Small intestinal injuries constitute more than half of all blunt intestinal injuries, with equal involvement of the jejunum and ileum. The second most frequent location of injury is the colon: some studies show that left colon is more commonly injured than the transverse or right colon [5,6]. Duodenal lesions are less common, representing 10% of the total and are often associated with pancreatic trauma.…”

Section: Discussionmentioning

confidence: 99%

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A big mesenteric rupture after blunt abdominal trauma: A case report and literature review

Stefanou

Tepelenis

et al. 2019

International Journal of Surgery Case Reports

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Highlights In a polytrauma patient with a blunt abdominal trauma and unclear imaging studies the urgent laparotomy is a better choice then wait and see. Intestinal and mesenteric injuries are less common and due to diagnostic difficulties they can result in therapeutic delay with severe complications. The preservation of the ileo-cecal is an important approach.

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Section: Discussionmentioning

confidence: 99%

“…They are third in order of frequency after liver and splenic injury [4]. These lesions occur as a result of high energy trauma, like motor vehicle accidents in 70–90% of the cases [[1], [2], [3], [4], [5], [6]]. The work in this case has been reported in line with the SCARE criteria [7].…”

Section: Introductionmentioning

confidence: 95%

A big mesenteric rupture after blunt abdominal trauma: A case report and literature review

Stefanou

Tepelenis

et al. 2019

International Journal of Surgery Case Reports

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“…The complication rate for EOR versus DOR was reported in nine studies (20)(21)(22)(23)(24)(25)(26)(27)(28). Overall, 1,008 and 404 patients received EOR and DOR, respectively.…”

Section: -Complication Ratementioning

confidence: 99%

Systematic surgical exploration or observation and selective exploration of suspected traumatic mesenteric and bowel injuries: A meta-analysis

Fugazzola

Tomasoni

Ceresoli

et al. 2021

ircmj

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Context: Mesenteric and bowel injuries (MBI) are rare and dangerous presentations of blunt abdominal trauma and often cause clinical uncertainty since their diagnosis is difficult and operative treatments are often delayed. No clear guidelines exist regarding this topic, and due to the rarity of the injury, few and highly low-quality data are available. This study aimed to compare early surgical exploration, delayed surgical exploration, and non-operative management in patients with proven and suspected blunt MBI. Evidence Acquisition: Detailed research was performed on Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases until 29th November 2019. The studies that were considered eligible to be included in this systematic review and consequent meta-analysis were those focusing on patients with proven MBI or computed tomography (CT) signs suspected for them and comparing early surgical exploration (EOR) with delayed one (DOR) or with selective surgical exploration (SOR) after clinical observation. The eligible studies were sub-grouped into those using a delay cut-off (to distinguish “early” and “deferred” surgical intervention) higher than 12 h and those using a cut-off lower than 12 h, as well as those focusing on patients with high-risk CT signs (pneumoperitoneum and active mesenteric bleeding) and those focusing on patients with low-risk ones. Results: Finally, 16 studies fulfilled the inclusion criteria and were included in the meta-analysis with a total of 2,702 patients. All studies, although not randomized, were considered to be at the acceptable risk of bias in the important domains. It was found that in patients with proven MBI, in the subgroup of studies with a delay cut-off for surgical intervention lower than 12 h, the complication rate was significantly lower in EOR, compared to DOR (risk ratio [RR]=0.47, 95% CI=0.29-0.79, P=0.004). In patients with suspected MBI with low-risk CT signs, the complication rate was significantly lower in SOR, compared to EOR (RR=1.79, 95% CI=1.27-2.53, P=0.001). It was also revealed that in patients with high-risk CT signs, the complication rate and the length of stay (LOS) were significantly lower in EOR, compared to DOR (complication: RR=0.38, 95% CI=0.17-0.84, P=0.02; LOS: mean difference=-12.00, 95% CI=-21.44-2.56, P=0.01). Conclusions: The present meta-analysis confirmed that in patients with proven blunt MBI a delay of surgical intervention higher than 12 h would lead to a higher complication rate and a longer LOS. Based on the results, in blunt trauma patients with pneumoperitoneum or active mesenteric bleeding at the admission CT scan, complications and LOS could be reduced by performing an early surgical exploration. On the other hand, in blunt trauma patients with low-risk CT signs of suspected MBI, a clinical observation with selective surgical exploration in case of clinical or radiological worsening could reduce the complication rate without increasing mortality and LOS.

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“…However, the use of seatbelts also created a new constellation of blunt abdominal injuries coined by Garrett and Braunstein in 1962 as "The Seat Belt Syndrome" [3] . Previous studies in the adult and pediatric population have estimated that abdominal seatbelt sign (SBS) is associated with hollow viscus injury (HVI) 15 to 64% of the time [4][5][6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

“…Computed tomographic (CT) imaging has supplanted the need for immediate laparotomy in patients with an abdominal SBS who do not present with peritonitis or hemodynamic instability. However, concern regarding the accuracy of CT in excluding HVI remains [4,[10][11][12] . The current guidelines by the Eastern Association for the Surgery of Trauma (EAST) recommend admission and serial exams for all patients with SBS and to consider laparotomy in any patients with free fluid on imaging [13] .…”

Section: Introductionmentioning

confidence: 99%

The use of computed tomography imaging for abdominal seatbelt sign: A single-center, prospective evaluation

Delaplain

Barrios

Spencer

et al. 2020

Injury

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Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital

Cited by 17 publications

References 18 publications

A big mesenteric rupture after blunt abdominal trauma: A case report and literature review

A big mesenteric rupture after blunt abdominal trauma: A case report and literature review

Systematic surgical exploration or observation and selective exploration of suspected traumatic mesenteric and bowel injuries: A meta-analysis

The use of computed tomography imaging for abdominal seatbelt sign: A single-center, prospective evaluation

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