Traumatic rupture of the ileum

Evans, J.P.

doi:10.1002/bjs.1800600207

Cited by 18 publications

(7 citation statements)

References 15 publications

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“…After the liver the intestines are the most commonly injured organ in penetrating injuries; only the spleen and liver are more frequently damaged in blunt trauma [1]. Mortality from penetrating intestinal injuries has dropped dramatically in this century, largely as a result of more rapid recognition and treatment [2][3][4]. The mortality of blunt intestinal trauma remains about 3 times that of penetrating injuries, due to the magnitude of force involved, the delay in diagnosis, or both [5].…”

mentioning

confidence: 99%

The management of duodenal and other small intestinal trama

1985

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One hundred sixty‐three patients were treated for blunt and penetrating trauma of the duodenum and small bowel over a 41/2‐year period at a major trauma center. Blunt injuries, mostly a result of vehicular trauma, comprised 17% of the cases, while stabbing and firearm injuries made up the remainder. Laboratory data, including white blood cell count, amylase, and abdominal x‐rays, were unreliable in predicting the presence of intestinal injury. Although only obtained in a few patients following blunt injury, computerized tomography (CT scan) of the abdomen was sensitive to intraperitoneal findings suggestive of or diagnostic for gastrointestinal injury. Speedy operative management is of the utmost importance; 63% of these patients were operated on in less than 2 hours from the initiation of medical treatment. The majority of intestinal damage can be repaired by simple closure or resection. Because of anatomic and physiologic considerations, complex operative procedures are required for the correction of some duodenal lesions. Our treatment of these injuries included frequent utilization of pyloric exclusion, as well as occasional diverticulization of the duodenum and pancreaticoduodenectomy. Delay in treatment and the magnitude and number of associated injuries contributed to increased morbidity and mortality, which was much higher in blunt trauma (21% versus 4% for penetrating injuries), especially when the duodenum was involved (36% mortality). Complications were also more common in the patients following blunt trauma and with multiple injuries. Infectious complications were the most frequent, with postoperative ileus or obstruction, hemorrhage, and iatrogenic complications occurring less often. In the majority of small bowel injuries, the management is straightforward and consists of operative repair as soon as possible. A high index of suspicion and reliance on diagnostic aids, such as CT scan, will speed the diagnosis of occult blunt intestinal injuries. Sound surgical judgment and facility with a variety of repairs is needed in the treatment of complex duodenal injuries.

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confidence: 99%

The management of duodenal and other small intestinal trama

1985

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“…Segments of the small bowel that are relatively fixed are particularly prone to this type of injury. This includes the terminal ileum, bowel involved in adhesions or hernias, or bowel with a shortened mesentry such as Crohn's disease, tuberculosis, or lymphoma [3,4]. Mesenteric hematomata and transverse tears of the mesentry commonly occur.…”

Section: Discussionmentioning

confidence: 99%

Seat belt‐induced trauma to the small bowel

et al. 1985

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Thirty‐two patients with seat belt‐induced injuries to the jejunum and ileum are reviewed. These patients are classified into 3 groups according to the nature and mechanism of injury. Group I consists of 4 patients with complete transection of the proximal jejunum caused by deceleration forces. Injuries commonly associated include spleen rupture and perforation of the transverse colon and splenic flexure. Group II consists of 6 patients with infarcted ileum caused by crushing forces. Associated injuries include tears to the cecum, aorta, and inferior vena cava. Group III consists of 22 patients with “blowout” perforations of the jejunum and ileum. These injuries are caused by transmitted forces. There are no associated specific injuries related to this group.

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“…In the duodenal loops included in their series the fluidfilled closed-loop specimen sustained a blow-out perforation whilst the empty open-ended specimen had only a sero-muscular injury. These closed-loop blow-out lesions are commoner in the proximal jejunum or distal ileum (Evans, 1973) but it would seem possible that this mechanism of injury could produce a duodenal perforation when the fluid-filled closed-loop situation was present. It has also been postulated that a hydraulic blow-out may occur when gastric contents are propelled under pressure through the open pylorus and strike the duodenal wall with enough force to rupture it.…”

Section: Mechanism Of Injurymentioning

confidence: 99%