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Incidence and risk factors for early small bowel obstruction after celiotomy for penetrating abdominal trauma
B J Tortella1, R F Lavery, A Chandrakantan
1New Jersey Trauma Center UMDNJ-University Hospital, Newark, USA.
Insights
Patients undergoing surgery for penetrating abdominal trauma face a higher risk of early Small Bowel Obstruction (SBO). Key risk factors include bowel injury and gunshot wounds, necessitating close follow-up.
Area of Science:
- Trauma Surgery
- Surgical Outcomes
- Gastrointestinal Surgery
Background:
- Postoperative Small Bowel Obstruction (SBO) is a known complication.
- The incidence of SBO after penetrating abdominal trauma (PAT) requires further investigation.
Purpose of the Study:
- To determine the incidence and identify risk factors for early SBO in patients with PAT.
- To compare SBO risk in PAT patients versus elective surgery patients.
Main Methods:
- Prospective cohort study at a Level 1 Trauma Center.
- Inclusion of patients requiring celiotomy for PAT.
- Minimum 6-month follow-up for readmission due to SBO.
Main Results:
- Overall early SBO incidence was 7.4% in evaluable PAT patients (n=298).
- Incidence varied from 2.3% (nontherapeutic celiotomy) to 10.8% (small/large bowel injury).
- PAT patients have increased early SBO risk compared to elective surgery patients; small/large bowel penetration and gunshot wounds are high-risk factors.
Conclusions:
- All patients undergoing celiotomy for PAT are at elevated risk for early SBO.
- Specific risk factors like bowel injury and gunshot wounds necessitate heightened clinical vigilance.
- Close follow-up is crucial for PAT patients, especially those with identified risk factors.
Abstract:
The reported overall incidence of postoperative Small Bowel Obstruction (SBO) is 0.69 per cent. This study examined the incidence and risk factors for early postoperative SBO for penetrating abdominal trauma (PAT), with early SBO defined as SBO within 6 months of operation. This was a prospective cohort study of patients admitted to a Level 1 Trauma Center from 5/91 to 12/93 who required celiotomy for PAT. Patients were followed at least 6 months for readmission for SBO to be considered evaluable. Of 341 patients undergoing celiotomy for PAT and surviving to discharge, 298 (87.4%) were evaluable. The overall incidence of early SBO was 7.4 per cent and varied between 2.3 per cent (nontherapeutic celiotomy) and 10.8 per cent (small/large bowel injury). All patients with celiotomy for PAT are at increased risk for early SBO compared with elective surgery patients. Those with small/large bowel penetration or gunshot wounds are at the highest risk. Previous abdominal surgery is not a risk factor for early SBO in PAT patients. Surgeons and Managed Care case managers should devote special attention to close follow-up in PAT patients, particularly those with the risk factors identified in this study.