Blunt abdominal trauma with jejunal injury: a review

Jejunal perforation is relatively common following focal blunt abdominal trauma. The mortality rate remains in the region of 30%. Significant factors affecting mortality are therapeutic delay of 24 hours or more, and multiple injuries. The commonest clinical features are abdominal pain, tenderness, and guarding, diminished or absent bowel sounds and signs of hypovolemia. Diagnostic difficulty is presented by the patient with an impaired level of consciousness and/or associated remote injuries which may distract the clinician from the abdomen. Delayed rupture may also occur, and observation should continue for at least 48 to 72 hours with a warning to return immediately if pain recurs. Straight abdominal and chest radiography are of limited diagnostic value, but nevertheless may prove helpful in 50% of cases. All patients with multiple injuries, particularly in the presence of a head injury with an impaired level of consciousness should be submitted to diagnostic abdominal paracentesis. A negative result should prompt diagnostic peritoneal lavage. Early diagnosis and aggressive therapy are essential if the mortality is to be reduced. To this end careful, frequent abdominal assessment should be practiced, with immediate laparotomy if clinical parameters deteriorate, or do not improve over a 12 to 18-hour period.