Mesenteric Injury after Blunt Abdominal Trauma

Xeropotamos, Nikolaos; Nousias, Vasilios; Ioannou, Christos V.; Kappas, Angelos M.

doi:10.1080/110241501750070547

Cited by 25 publications

(6 citation statements)

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“…In a series reporting 333 cases of blunt abdominal trauma including 31 mesenteric injuries, 30 of these were small bowel devascularisation with only four large bowel devascularisation injuries [7]. Cripps and Cooper reported that small bowel injuries were associated with high velocity impacts irrespective of the degree of abdominal compression, while large bowel injuries occur at both high and low velocity impacts associated with abdominal compression [8].…”

Section: Discussionmentioning

confidence: 99%

Seatbelt Injury Causing Small Bowel Devascularisation: Case Series and Review of the Literature

O'Dowd

Kiernan

Lowery

et al. 2011

Emergency Medicine International

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The use of seatbelts has increased significantly in the last twenty years, leading to a decrease in mortality from road traffic accidents (RTA). However, this increase in seatbelt use has also led to a change in the spectrum of injuries from RTA; abdominal injuries, particularly intestinal injuries have dramatically increased with the routine use of seatbelts. Such intestinal injuries frequently result from improper placement of the “lap belt”. We present 3 cases in which passengers wearing a seatbelt sustained significant devascularisation injuries to the small bowel requiring emergency surgical intervention. A high index of suspicion is crucial in such cases to prevent delays in diagnosis that can lead to severe complications and adverse outcomes. It is evident that while advocating seatbelt use, the importance of education in correct seatbelt placement should also be a focus of public health strategies to reduce RTA morbidity and mortality.

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Section: Discussionmentioning

confidence: 99%

Seatbelt Injury Causing Small Bowel Devascularisation: Case Series and Review of the Literature

O'Dowd

Kiernan

Lowery

et al. 2011

Emergency Medicine International

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“…Management entails operative exploration once a diagnosis of small bowel obstruction is made. It is well documented that early operation improves survival and decreases morbidity ( 6 , 13 , 14 ). Our patient benefited from immediate CT scans and operative intervention by minimal bowel resection with subsequent discharge to his normal environment and occupation.…”

Section: Discussionmentioning

confidence: 99%

Asynchronous Small Bowel Obstruction: A Complication of Blunt Abdominal Trauma

Mahmood¹,

Mahmood²,

Busch³

2007

Radiology Case Reports

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A 38-year-old male who sustained blunt abdominal trauma at work presented to the emergency department with complaints of abdominal pain localized primarily in the peri-umbilical region. The patient was discharged home after a brief uneventful hospitalization only to return 13 days later with signs and symptoms of acute bowel obstruction. Following clinical and radiological workup, a computed tomography (CT) scan was obtained which revealed markedly dilated and thickened bowel, induration and vascular congestion seen along the adjacent mesentery with fat stranding. The patient was taken emergently to the operating room (OR) where a small mesenteric defect was found, secondary to trauma, facilitating an internal hernia precipitating a small bowel obstruction. We urge the surgeon to maintain a low index of suspicion for acute bowel obstruction in the blunt trauma population. A CT scan is essential in evaluating this patient population and we cannot underscore enough the importance and value of this modality in radiologic imaging. We further recommend resection of the compromised bowel and associated mesentery.

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“…The complication rate for EOR versus DOR was reported in nine studies (20)(21)(22)(23)(24)(25)(26)(27)(28). Overall, 1,008 and 404 patients received EOR and DOR, respectively.…”

Section: -Complication Ratementioning

confidence: 99%

“…Length of stay was reported in 4 studies (20,22,26,28) for EOR versus DOR. Overall, 434 and 268 patients respectively received EOR and DOR.…”

Section: -Length Of Staymentioning

confidence: 99%

Systematic surgical exploration or observation and selective exploration of suspected traumatic mesenteric and bowel injuries: A meta-analysis

Fugazzola

Tomasoni

Ceresoli

et al. 2021

ircmj

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Context: Mesenteric and bowel injuries (MBI) are rare and dangerous presentations of blunt abdominal trauma and often cause clinical uncertainty since their diagnosis is difficult and operative treatments are often delayed. No clear guidelines exist regarding this topic, and due to the rarity of the injury, few and highly low-quality data are available. This study aimed to compare early surgical exploration, delayed surgical exploration, and non-operative management in patients with proven and suspected blunt MBI. Evidence Acquisition: Detailed research was performed on Medline, Embase, PubMed, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews databases until 29th November 2019. The studies that were considered eligible to be included in this systematic review and consequent meta-analysis were those focusing on patients with proven MBI or computed tomography (CT) signs suspected for them and comparing early surgical exploration (EOR) with delayed one (DOR) or with selective surgical exploration (SOR) after clinical observation. The eligible studies were sub-grouped into those using a delay cut-off (to distinguish “early” and “deferred” surgical intervention) higher than 12 h and those using a cut-off lower than 12 h, as well as those focusing on patients with high-risk CT signs (pneumoperitoneum and active mesenteric bleeding) and those focusing on patients with low-risk ones. Results: Finally, 16 studies fulfilled the inclusion criteria and were included in the meta-analysis with a total of 2,702 patients. All studies, although not randomized, were considered to be at the acceptable risk of bias in the important domains. It was found that in patients with proven MBI, in the subgroup of studies with a delay cut-off for surgical intervention lower than 12 h, the complication rate was significantly lower in EOR, compared to DOR (risk ratio [RR]=0.47, 95% CI=0.29-0.79, P=0.004). In patients with suspected MBI with low-risk CT signs, the complication rate was significantly lower in SOR, compared to EOR (RR=1.79, 95% CI=1.27-2.53, P=0.001). It was also revealed that in patients with high-risk CT signs, the complication rate and the length of stay (LOS) were significantly lower in EOR, compared to DOR (complication: RR=0.38, 95% CI=0.17-0.84, P=0.02; LOS: mean difference=-12.00, 95% CI=-21.44-2.56, P=0.01). Conclusions: The present meta-analysis confirmed that in patients with proven blunt MBI a delay of surgical intervention higher than 12 h would lead to a higher complication rate and a longer LOS. Based on the results, in blunt trauma patients with pneumoperitoneum or active mesenteric bleeding at the admission CT scan, complications and LOS could be reduced by performing an early surgical exploration. On the other hand, in blunt trauma patients with low-risk CT signs of suspected MBI, a clinical observation with selective surgical exploration in case of clinical or radiological worsening could reduce the complication rate without increasing mortality and LOS.

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Mesenteric Injury after Blunt Abdominal Trauma

Abstract: Because delay in diagnosis is significantly associated with morbidity and duration of hospital stay we recommend that all patients admitted with blunt abdominal trauma should have a diagnostic peritoneal lavage as soon as possible

Cited by 25 publications

References 0 publications

Seatbelt Injury Causing Small Bowel Devascularisation: Case Series and Review of the Literature

Seatbelt Injury Causing Small Bowel Devascularisation: Case Series and Review of the Literature

Asynchronous Small Bowel Obstruction: A Complication of Blunt Abdominal Trauma

Systematic surgical exploration or observation and selective exploration of suspected traumatic mesenteric and bowel injuries: A meta-analysis

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