Intestinal infarction after nonabdominal trauma; association with cerebral trauma

Area of Science:

• Trauma critical care
• Gastrointestinal surgery
• Neurological injury management

Background:

• Nonocclusive bowel infarction is infrequently reported in nonabdominal trauma.
• Hypotension is often cited as a cause, but not consistently observed.
• The incidence and causes in a traumatologic intensive care unit (ICU) setting require further investigation.

Purpose of the Study:

• To determine the frequency of intestinal infarction in a traumatologic ICU.
• To identify potential causes and clinical presentations of this complication in severe head trauma patients.
• To evaluate diagnostic challenges and patient outcomes.

Main Methods:

• Retrospective analysis of 2350 patients admitted to a traumatologic ICU from 1977 to 1986.
• Inclusion criteria: diagnosis of intestinal infarction at surgery or autopsy, exclusion of patients with pre-existing vascular disease.
• Detailed review of patient demographics, injury severity (Head and Neck Abbreviated Injury Scale, Injury Severity Score), neurological status (Glasgow Coma Scale), treatment, and outcomes.

Main Results:

• 12 cases (0.5% incidence) of nonocclusive bowel infarction were identified in patients with severe cerebral trauma (AIS 4-5, GCS 6.5).
• Common presenting symptoms included sepsis and multiple organ failure with abdominal distention.
• Dehydration and diuretic therapy were identified as the most frequent contributing factors.

Conclusions:

• Early diagnosis of intestinal infarction in ventilated head-injured patients is challenging due to patient heterogeneity, low incidence, and complex clinical presentation.
• Severe cerebral trauma, dehydration, and diuretic therapy are significant risk factors.
• Surgical intervention in patients with favorable cerebral prognosis offered a chance for recovery.