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Annals of The Royal College of Surgeons of England logoLink to Annals of The Royal College of Surgeons of England
. 2000 Mar;82(2):103–106.

Presentation of blunt small intestinal and mesenteric injuries.

E Pikoulis 1, S Delis 1, N Psalidas 1, A Leppäniemi 1, K Derlopas 1, E Pavlakis 1, S Mantonakis 1
PMCID: PMC2503515  PMID: 10743427

Abstract

During the 10 year period from 1988 to 1997, 64 patients with blunt small bowel and mesenteric injuries were treated at two trauma centres. The majority (52 cases) were victims of motor vehicle accidents, and 54% of them wore seat belts at the time of the accident. There were 22 small bowel injuries (17 full-thickness and 5 seromuscular) and 42 mesenteric injuries (7 with and 35 without a devascularised bowel segment). Shock on admission was present in 34% of the patients and generalised abdominal tenderness in 75%. Diagnostic peritoneal lavage was positive for blood in 25 out of 36 cases in which it was performed (69%), and positive for bowel content in 4/6 patients (67%) with full-thickness bowel perforations or transactions. Emergency room ultrasound was positive for blood in 13/25 cases (52%), and CT scan in 7/17 (41%). It is concluded that blunt small bowel and mesenteric injuries including patients with perforated or ischaemic bowel are difficult to diagnose using currently available diagnostic tools, and require a low threshold for exploration based on clinical suspicion in order to reduce the complications following delayed treatment of these injuries.

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Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Bloom A. I., Rivkind A., Zamir G., Gross E., Kluger Y., Reissman P., Muggia-Sullam M. Blunt injury of the small intestine and mesentery--the trauma surgeon's Achilles heel? Eur J Emerg Med. 1996 Jun;3(2):85–91. doi: 10.1097/00063110-199606000-00005. [DOI] [PubMed] [Google Scholar]
  2. Ceelen W., Hesse U., De Hemptinne B. Small bowel perforation following blunt abdominal trauma. Acta Chir Belg. 1995;95(4 Suppl):187–189. [PubMed] [Google Scholar]
  3. Cobb L. M., Vinocur C. D., Wagner C. W., Weintraub W. H. Intestinal perforation due to blunt trauma in children in an era of increased nonoperative treatment. J Trauma. 1986 May;26(5):461–463. doi: 10.1097/00005373-198605000-00009. [DOI] [PubMed] [Google Scholar]
  4. Dauterive A. H., Flancbaum L., Cox E. F. Blunt intestinal trauma. A modern-day review. Ann Surg. 1985 Feb;201(2):198–203. doi: 10.1097/00000658-198502000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Donohue J. H., Federle M. P., Griffiths B. G., Trunkey D. D. Computed tomography in the diagnosis of blunt intestinal and mesenteric injuries. J Trauma. 1987 Jan;27(1):11–17. doi: 10.1097/00005373-198701000-00003. [DOI] [PubMed] [Google Scholar]
  6. Evans J. P. Traumatic rupture of the ileum. Br J Surg. 1973 Feb;60(2):119–121. doi: 10.1002/bjs.1800600207. [DOI] [PubMed] [Google Scholar]
  7. Evers K., DeGaeta L. R. Abdominal trauma. Emerg Med Clin North Am. 1985 Aug;3(3):525–539. [PubMed] [Google Scholar]
  8. Guarino J., Hassett J. M., Jr, Luchette F. A. Small bowel injuries: mechanisms, patterns, and outcome. J Trauma. 1995 Dec;39(6):1076–1080. doi: 10.1097/00005373-199512000-00011. [DOI] [PubMed] [Google Scholar]
  9. Hernanz-Schulman M., Genieser N. B., Ambrosino M. Sonographic diagnosis of intramural duodenal hematoma. J Ultrasound Med. 1989 May;8(5):273–276. doi: 10.7863/jum.1989.8.5.273. [DOI] [PubMed] [Google Scholar]
  10. Marx J. A., Bar-Or D., Moore E. E., Tercier J. A. Utility of lavage alkaline phosphatase in detection of isolated small intestinal injury. Ann Emerg Med. 1985 Jan;14(1):10–14. doi: 10.1016/s0196-0644(85)80726-5. [DOI] [PubMed] [Google Scholar]
  11. Marx J. A., Moore E. E., Jorden R. C., Eule J., Jr Limitations of computed tomography in the evaluation of acute abdominal trauma: a prospective comparison with diagnostic peritoneal lavage. J Trauma. 1985 Oct;25(10):933–937. doi: 10.1097/00005373-198510000-00002. [DOI] [PubMed] [Google Scholar]
  12. Meyer D. M., Thal E. R., Weigelt J. A., Redman H. C. Evaluation of computed tomography and diagnostic peritoneal lavage in blunt abdominal trauma. J Trauma. 1989 Aug;29(8):1168–1172. doi: 10.1097/00005373-198908000-00017. [DOI] [PubMed] [Google Scholar]
  13. Munns J., Richardson M., Hewett P. A review of intestinal injury from blunt abdominal trauma. Aust N Z J Surg. 1995 Dec;65(12):857–860. doi: 10.1111/j.1445-2197.1995.tb00576.x. [DOI] [PubMed] [Google Scholar]
  14. Phillips T. F., Brotman S., Cleveland S., Cowley R. A. Perforating injuries of the small bowel from blunt abdominal trauma. Ann Emerg Med. 1983 Feb;12(2):75–79. doi: 10.1016/s0196-0644(83)80376-x. [DOI] [PubMed] [Google Scholar]
  15. Sherck J., Shatney C., Sensaki K., Selivanov V. The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation. Am J Surg. 1994 Dec;168(6):670–675. doi: 10.1016/s0002-9610(05)80142-4. [DOI] [PubMed] [Google Scholar]
  16. Stevens S. L., Maull K. I. Small bowel injuries. Surg Clin North Am. 1990 Jun;70(3):541–560. doi: 10.1016/s0039-6109(16)45129-7. [DOI] [PubMed] [Google Scholar]
  17. Taylor G. A., Fallat M. E., Potter B. M., Eichelberger M. R. The role of computed tomography in blunt abdominal trauma in children. J Trauma. 1988 Dec;28(12):1660–1664. doi: 10.1097/00005373-198812000-00008. [DOI] [PubMed] [Google Scholar]
  18. Thal E. R., Shires G. T. Peritoneal lavage in blunt abdominal trauma. Am J Surg. 1973 Jan;125(1):64–69. doi: 10.1016/0002-9610(73)90009-3. [DOI] [PubMed] [Google Scholar]

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