Publication:

Recognition and management of small bowel and mesenteric injuries in blunt abdominal trauma

Background The small intestine is the third most commonly injured organ in blunt abdominal trauma (BAT) following liver and spleen. As the non-operative management of BAT becomes increasingly accepted by surgeons the concern arises whether small bowel and mesenteric injuries are being missed or recognized after a delay. In patients sustaining BAT the role of clinical assessment or imaging is being continually evaluated. Objective of the study was to evaluate the role of clinical assessment, imaging in establishing the diagnosis of small bowel / mesenteric injuries in BAT and outcome of patientsMethods: The study was conducted at tertiary care center over a period of 2 years. It was planned as a retrospective observational study which looked at patients with BAT who underwent laparotomy and were found to have small bowel/mesenteric injuries. The case records were reviewed with a view to analyze what prompted the decision to operate and the time to laparotomy.

Results Out of 74 patients operated for BAT 29 had small bowel and mesenteric injuries. Amongst these 29 patients the decision of laparotomy was taken primarily on clinical assessment in 11 patients and in the other 18 patients imaging helped in identifying the injury. 25 perforations of small bowel and 5 mesenteric injuries with small bowel ischemia were noted. 2 patients died despite surgical intervention.

Conclusions Patients with BAT can be recognized based on clinical assessment and selective imaging.