Double ischemic ileal stenosis secondary to mesenteric injury after blunt abdominal trauma

Bougard, Valérie; Avisse, C.; Patey, Martine; Germain, Denis; Levy-Chazal, N.; Delattre, Jean-François

doi:10.3748/wjg.14.143

Cited by 7 publications

(4 citation statements)

References 12 publications

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“…In fact, in several case reports, delayed ischemic stenosis due to blunt mesenteric injury has been reported. In these cases, stenosis or decreased motility was confirmed through surgery, and even if the patient did not have direct bowel injury, bowel function impairment could occur through mesenteric injury [40,41].…”

Section: Discussionmentioning

confidence: 99%

Factors associated with enteral nutrition tolerance after trauma laparotomy of the small bowel and mesenteric injuries by blunt trauma

Jang

Lee

et al. 2023

BMC Surg

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Background In patients with blunt injury due to abdominal trauma, the common cause for laparotomy is damage to the small bowel and mesentery. Recently, postoperative early enteral nutrition (EEN) has been recommended for abdominal surgery. However, EEN in patients with blunt bowel and/or mesenteric injury (BBMI) has not been established. Therefore, this study aimed to identify the factors that affect early postoperative small bowel obstruction (EPSBO) and the date of tolerance to solid food and defecation (SF + D) after surgery in patients with BBMI. Methods We retrospectively reviewed patients who underwent laparotomy for BBMI at a single regional trauma center between January 2013 and July 2021. A total of 257 patients were included to analyze the factors associated with enteral nutrition tolerance in patients with EPSBO and the postoperative day of tolerance to SF + D. Results The incidence of EPSBO in patients with BBMI was affected by male sex, small bowel organ injury scale (OIS) score, mesentery OIS score, amount of crystalloid, blood transfusion, and postoperative drain removal date. The higher the mesentery OIS score, the higher was the EPSBO incidence, whereas the small bowel OIS did not increase the incidence of EPSBO. The amount of crystalloid infused within 24 h; the amount of packed red blood cells, fresh frozen plasma, and platelet concentrate transfused; the time of drain removal; Injury Severity Score; and extremity abbreviated injury scale (AIS) score were correlated with the day of tolerance to SF + D. Multivariate analysis between the EPSBO and non-EPSBO groups identified mesentery and small bowel OIS scores as the factors related to EPSBO. Conclusion Mesenteric injury has a greater impact on EPSBO than small bowel injury. Further research is needed to determine whether the mesentery OIS score should be considered during EEN in patients with BBMI. The amount of crystalloid infused and transfused blood components within 24 h, time of drain removal, injury severity score, and extremity AIS score are related to the postoperative day on which patients can tolerate SF + D.

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Section: Discussionmentioning

confidence: 99%

Factors associated with enteral nutrition tolerance after trauma laparotomy of the small bowel and mesenteric injuries by blunt trauma

Jang

Lee

et al. 2023

BMC Surg

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“…Patients with a history of abdominal trauma and symptoms of bowel obstruction should preferably be investigated with contrast-enhanced abdominal and pelvic CT scans and later colonoscopy [ 8 ]. Criteria proposed for the diagnosis of bowel obstruction after blunt abdominal trauma include the appropriate history, no similar attacks before the trauma, onset of symptoms after the trauma, confirmation of bowel stenosis, and exclusion of other specific neoplastic or inflammatory diseases in the related bowel segment [ 3 ], all of which were applicable in our case.…”

Section: Discussionmentioning

confidence: 99%

Delayed presentation of bowel obstruction after abdominal blunt trauma

Shalhoub

Alghamdi

Alsannaa

2021

Trauma Case Reports

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Blunt abdominal trauma is a rare cause of small bowel obstruction thought to arise from either a sealed perforation of the small bowel or mesenteric injury resulting in adhesions. A 55-year-old gentleman presented with symptoms and signs of small bowel obstruction and a history of blunt abdominal trauma 14 months previously. Abdominal computed tomography showed a transition zone at the terminal ilium with proximal dilatation indicative of obstruction. At surgery, he had adhesions involving the terminal ilium with shortening and fibrosis of the supplying mesentery. Patients with a history of blunt abdominal trauma presenting with abdominal symptoms must be investigated to rule out bowel obstruction, with a low threshold for surgical intervention.

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“…The longer operating time and the higher rate of superficial wound infections in the case of resection [3] have to be balanced against the risks of a nonresected intestinal wall injury as an independent risk factor for complications and higher mortality rate [1]. Ulceration/transmural necrosis of the bowel can lead to bacterial invasion and perforation, or if healing is possible, it can lead to later development of fibrotic stenosis [7, 14]. Considering the very low risk of an anastomotic leak [13], this can be avoided by resection of bowel segments with persistent strangulation marks.…”

Section: Discussionmentioning

confidence: 99%