Prediction of the delayed complications of intestinal and mesenteric injuries following experimental blunt abdominal trauma

Abstract

Injuries to the intestine and mesentery are often found in patients undergoing laparotomy for blunt abdominal trauma. Although treatment of perforations is relatively straightforward, the same is not true for contusions. Few guidelines exist at present to aid the surgeon in deciding which injuries require resection in order to avoid the complications of delayed perforation and late stricture formation. The natural history of these non-perforating intestinal and mesenteric injuries has been examined in an experimental model to identify possible criteria on which future management can be based. In the immediate postinjury period peristalsis and local mesenteric pulsation were absent in the majority of injuries which went on to full recovery and these observations are thus of little predictive value in predicting outcome. The initial size of contusion (length of contusion along longitudinal axis of bowel) relative to bowel wall circumference (BWC) was related to complications as follows: contusion less than BWC (n = 47)--one complication; contusion greater than BWC (n = 8)--three complications (P = 0.02). Similarly, six mesenteric injuries which produced an initial ischaemia (assessed by fluorescein) less than twice the BWC did not result in any complications, compared with four complications which occurred in ten cases when the initial ischaemia was greater than twice the BWC. These results go some way towards providing a better understanding of these injuries and in turn may help the emergency surgeon in deciding which injuries require resection.

Delayed intestinal perforation secondary to blunt force abdominal trauma in a cat

“…Following 55 separate insults, only two incidents of perforation were reported. 20 In a study focused on severe blunt trauma in dogs, there were no reports of intestinal perforation, even though approximately 70% of cases presented with abdominal trauma. The most common injuries reported were hemoperitoneum (23%), abdominal hernia (5%) and urinary tract rupture (3%).…”

Role of exploratory laparoscopy in haemodynamically stable patient with a penetrating abdominal trauma

“…Although requiring general anaesthesia and experienced laparoscopist, it could achieve 90–100% sensitivity in evaluating abdominal trauma, shorter hospital stay and cost-effective [ 4 , 5 ]. In this case, therapeutic laparoscopy was also carried out and this had saved the patient from the possibility of delayed perforation of the bowel and late formation of stricture [ 6 ].…”

Delayed jejunal perforation following blunt abdominal trauma

“…The second patient also had multiple strictures. The sequence of events could be: (i) mesenteric/ intramural contusions at the time of injury or bowel ischaemia following mesenteric injury; 4,5 (ii) stricture formation -these sites are probably weaker and less elastic compared to normal bowel; and (iii) perforation occurring later following increased intraluminal pressure. The presence of organising granulation tissue on histological examination could support this hypothesis.…”