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Small bowel perforation: is urgent surgery necessary?
1Department of Surgery, Chang-Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan, Republic of China.
The Journal of Trauma
|September 25, 1999
Summary
Timely treatment of small bowel perforation after blunt abdominal trauma is crucial. While mortality remains low, delaying surgery over 24 hours significantly increases complications and prolongs recovery, highlighting the need for accurate diagnostic methods.
Area of Science:
- Trauma Surgery
- Surgical Diagnostics
- Abdominal Trauma Management
Background:
- Small bowel perforation following blunt abdominal trauma presents diagnostic and treatment challenges.
- Current literature shows controversy regarding optimal diagnostic and treatment strategies.
- Early diagnosis and timely intervention are critical for patient outcomes.
Purpose of the Study:
- To assess the impact of treatment delay on outcomes of small bowel perforation after blunt abdominal trauma.
- To identify the most effective diagnostic assessment plan for early detection of this injury.
Main Methods:
- Retrospective review of 111 patients with small bowel perforations from blunt abdominal trauma.
- Patients categorized into four groups based on time to surgery.
- Comparison of hospital stay, oral intake resumption, mortality, and morbidity rates.
- Analysis of physical signs, laboratory tests, CT scans, and diagnostic peritoneal lavage (DPL) for diagnostic accuracy.
Main Results:
- Delaying surgery beyond 24 hours did not significantly increase mortality but dramatically increased complications.
- Extended hospital stay and delayed oral intake resumption were observed with delayed surgery.
- Abdominal tenderness was common but not specific; CT scans had limited diagnostic value (40% diagnostic, 50% suggestive, 10% negative).
- Diagnostic peritoneal lavage, using specific criteria (cell count ratio, amylase activity, presence of particulate matter/bacteria), accurately diagnosed all intraperitoneal bowel perforations.
Conclusions:
- Small bowel perforation has low mortality and complication rates when treated within 24 hours.
- Immediate surgery is not always necessary for stable patients; a detailed examination is prioritized.
- Treatment for small bowel perforation should be prioritized after limb-threatening injuries.
- Diagnostic peritoneal lavage, with specific positive criteria, offers high sensitivity and specificity for diagnosing small bowel perforation.