Small bowel injuries following blunt abdominal trauma. Early recognition and management

We reviewed the cases of 15 patients with intestinal perforation following blunt abdominal trauma, which occurred between 1971 and 1988. Twelve patients were treated at The Mary Imogene Bassett Hospital (Cooperstown, NY); three other patients were treated at surrounding area hospitals. These injuries included 11 motor vehicle accidents, three low-velocity impact injuries, and one blast injury. There were four duodenal, ten jejunal, and two ileal injuries. Five patients who were operated on within 12 hours had classic signs of peritonitis or gross blood on diagnostic peritoneal lavage. Four patients were operated on after 12 hours, and six after 24 hours; physical signs were subtle in this group. Pain was a universal finding but was usually moderate; nausea and vomiting were frequent early findings in the ten patients with late recognition. An altered sensorium due to intoxication or head injury was present in three of ten patients operated on after 12 hours. Laboratory determinations, including a white blood cell count and amylase analysis, as well as abdominal radiographs, were often not helpful. Diagnostic peritoneal lavage is an important test, but when it is performed within four hours post-injury, it may yield false negative findings in up to 50% of patients and may need to be repeated. Computer tomographic scanning should employ oral and intravenous contrast to increase accuracy; perforation of a hollow viscus may not be immediately recognized. Four of the five patients operated on within 12 hours had an uncomplicated course. Complications occurred in all six patients operated on beyond 24 hours and included intraabdominal abscesses in five, and death for one patient.(ABSTRACT TRUNCATED AT 250 WORDS)