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[Small bowel injuries in blunt abdominal trauma--a diagnostic problem!]
J Metzger1, M von Flüe, R Babst
1Departement Chirurgie, Kantonsspital Basel.
Swiss Surgery = Schweizer Chirurgie = Chirurgie Suisse = Chirurgia Svizzera
|January 1, 1995
Summary
Diagnosing blunt abdominal trauma injuries to the small bowel is challenging. Early diagnosis requires repeated imaging, as initial tests like ultrasound and X-rays are often insufficient for detecting these rare injuries.
Area of Science:
- Trauma Surgery
- Diagnostic Imaging
- Abdominal Injuries
Background:
- Small bowel injuries from blunt abdominal trauma are rare, occurring in approximately 6% of cases.
- These injuries are notoriously difficult to diagnose, leading to delayed recognition and treatment.
- Effective diagnostic strategies are crucial for improving patient outcomes.
Purpose of the Study:
- To analyze diagnostic sequences for small bowel injuries following blunt abdominal trauma.
- To compare institutional findings with existing literature.
- To establish an improved diagnostic pathway for this rare condition.
Main Methods:
- Retrospective analysis of diagnostic procedures for 13 patients with blunt small bowel trauma.
- Evaluation of diagnostic tools including peritoneal lavage, ultrasound, and X-ray.
- Comparison of diagnostic timelines and accuracy.
Main Results:
- Two of 13 patients died upon arrival; 11 were assessed further.
- Initial diagnostic tools (ultrasound, lavage, X-ray) showed poor sensitivity in patients without peritonitis.
- Diagnosis was achieved within 24 hours for 7 of 11 patients; 4 patients were diagnosed after an average of 11 days.
Conclusions:
- Initial diagnostic assessments for blunt small bowel injuries are often inadequate.
- Repeated imaging, particularly ultrasound, is recommended for monitoring.
- Computed tomography (CT) is valuable for hemodynamically stable patients with suspected injuries, while diagnostic laparoscopy's role remains unclear. Delayed perforation due to ischemia should be considered.