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[Jejunum perforation following blunt abdominal trauma--a case report]
J M Lindenmann1, D Schmid, A Akovbiantz
1Chirurgische Abteilung Schweiz. Pflegerinnenschule, Zürich.
Schweizerische Rundschau Fur Medizin Praxis = Revue Suisse De Medecine Praxis
|August 2, 1994
Summary
Blunt abdominal trauma can cause rare small bowel perforations, often presenting with subtle symptoms like abdominal pain. Prompt diagnosis and surgical intervention are crucial to reduce high mortality rates associated with these injuries.
Area of Science:
- Trauma Surgery
- Gastrointestinal Surgery
Background:
- Small bowel perforation following blunt abdominal trauma is uncommon.
- Deceleration injuries, typically from traffic accidents, are the most frequent cause.
Observation:
- Clinical signs of enteric lesions are often nonspecific, with abdominal pain being the most common symptom.
- A lack of bowel sounds is noted in 64% of cases.
- Imaging studies like sonography and computed tomography have limited diagnostic utility.
Findings:
- Enteric lesions should be suspected with a history of trauma and coexisting pathologies such as vertebral or pelvic fractures.
- Delayed perforations may necessitate prolonged observation (48–72 hours).
- Initial radiography may not reveal free air in less than 50% of cases, complicating early diagnosis.
Implications:
- High mortality rates (30%) are associated with delayed diagnosis (>10 hours) and concurrent organ injuries.
- Immediate antibiotic treatment (cephalosporin, aminoglycoside, metronidazole) is recommended during surgical intervention for peritonitis.
- Postoperative complications include septicaemia, wound infections, and enterocutaneous fistulae.