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Small bowel injuries: mechanisms, patterns, and outcome
J Guarino1, J M Hassett, F A Luchette
1State University of New York at Buffalo, Department of Surgery Erie County Medical Center, USA.
Objectives:
To determine the relationship between mechanism of injury (MI), operative management (OM), and outcome for traumatic jejunal and ileal wounds using an aggressive diagnostic, therapeutic, and support protocol.
Methods:
Medical records for patients discharged with small bowel injuries from the Trauma Service between 1988 and 1992 were reviewed. The MI, presence of shock, method of diagnosis, OM, morbidity, and mortality were analyzed.
Results:
Seventy patients had jejunal and/or ileal injuries. Blunt mechanisms caused injury in 33%, whereas the rest were penetrating wounds. Twenty-one diagnostic peritoneal lavages facilitated diagnosis (71% positive by tap). Ninety-six percent of the patients were explored within 3 hours of admission. Multiple perforations of jejunum were the most common injury of the small bowel. Using the Organ Injury Scale, grade III and IV wounds were statistically more common with penetrating injuries. Most of the injuries were managed with resection and stapled anastomosis, even in the presence of shock.
Conclusions:
There is a significant difference in MI and OM for small bowel wounds. Resection and stapled anastomosis is safe even in the presence of shock. Mortality and morbidity are related to associated injuries.