The Mechanism of Intestinal Injury in Trauma

Williams, Roger D.; Sargent, Frank

doi:10.1097/00005373-196305000-00011

Cited by 107 publications

(24 citation statements)

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“…Injury to abdominal viscera has been attributed to compression between the safety-belt and the vertebral column (Williams and Sargent, 1963). Considerable shearing forces would act particularly on the less mobile viscera, such as the duodenum, producing transection or perforation as in Cases 2 and 4.…”

Section: Discussionmentioning

confidence: 99%

Seat-belt Injuries

Hamilton¹

1968

BMJ

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Summary: The drivers and passengers of two cars which collided head-on all wore lap and diagonal seatbelts. Three of the four suffered ruptured viscera and two incurred flexion-compression fractures of the neck.A victim of a traffic accident who was wearing a seatbelt and who has superficial bruising or pain presents a difficult diagnostic problem. Visceral injury should be suspected in such cases.

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Section: Discussionmentioning

confidence: 99%

Seat-belt Injuries

Hamilton¹

1968

BMJ

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“…Such mechanisms seem to be favored by most authors. 10,15,16 This is similar to the mechanism described in duodenal-jejunal injury associated with safety belts in motor vehicle accidents: The duodenum or jejunum is compressed between the safety belt or steering wheel and vertebral column. This is often associated with a chance of fracture of the vertebral column.…”

Section: Discussionmentioning

confidence: 60%

Jejunal Tackle

Perry

Fischer²,

Wakeman³

2014

Clinical Journal of Sport Medicine

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Jejunal perforation as a result of blunt abdominal trauma during sport is particularly rare. We are aware of 6 reported cases of jejunal perforation in sport: 1 in hockey, 2 in football (soccer), and 3 in American football. This report presents the case of a 25-year-old professional rugby union player, who presented to an "After Hours" general practice clinic with increasing central abdominal and epigastric pain after a heavy tackle during an international match in New Zealand. Despite suffering complete jejunal transection, the patient continued to play on, only presenting to an After Hours general practice clinic 3 hours after the injury. The case demonstrates the remarkable physiological resilience of professional rugby players and acts as a reminder to maintain a high degree of suspicion for small bowel injury despite normal vital signs in healthy young patients with abdominal pain secondary to blunt trauma.

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“…[3][4][5] Morbidity and mortality due to delayed diagnosis occur as a result of haemorrhage of injured mesenteric vessels and peritonitis from bowel wall rupture or bowel ischaemia. Patients with a slow oozing mesenteric haematoma may remain clinically undetected for days, until bowel necrosis occurs leading to peritonitis.…”

Section: Discussionmentioning

confidence: 99%

Mesenteric injury caused by minor blunt abdominal trauma

Rf¹,

et al. 2006

Emergency Medicine Journal

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The authors present an unusual case of mesenteric injury caused by minor blunt abdominal trauma and also provide a review of the literature. M esenteric injury from blunt abdominal trauma is uncommon and can be difficult to diagnose. 1 It is known that seatbelt trauma from motor vehicle accidents is the most common mechanism of mesenteric injury and that the mesentery of the small bowel is injured more frequently than that of the colon. 2 We present an unusual case of mesenteric injury caused by minor blunt abdominal trauma and go on to provide a thorough review of the literature. CASE REPORTA 63 year old male presented to the emergency department with progressive, dull epigastralgia for two days. He reported that the pain was a result of blunt abdominal injury from being hit by his 3 year old grandson's head while playing. His family witnessed the scenario and stated that the patient was fine except for mild abdominal pain after the collision. There was no significant past medical history. His vital signs on presentation were blood pressure 92/50 mm Hg, heart rate 94 beats/minute, respiratory rate 22 breaths/minute, and temperature 35.9˚C (96.2˚F). Physical examination was remarkable only in the abdomen which was distended and diffusely tender to palpation. Laboratory tests showed a haematocrit of 38.6%, serum creatinine 1.5 mg/dl, and amylase 64 U/l. The coagulation profile was within normal limits. A rapid trauma sonography demonstrated free intraperitoneal fluid.After stabilisation of his vital signs, a contrast enhanced abdominal computed tomography (CT) was obtained, which showed the presence of ascites and mesenteric haematoma (fig 1). Internal bleeding was confirmed by peritoneocentesis which yielded bloody fluid and the patient was then sent to the theater for an emergent celiotomy. Intraoperative findings revealed the presence of up to one litre of bloody ascites and a stable mesenteric haematoma adjacent to the Treitz ligament. Surgical repair was performed. The spleen, pancreas, liver, duodenum, and small and large bowels were all intact. The postoperation course was uncomplicated and he was discharged on day 15 after admission. DISCUSSIONSThe mechanism of mesenteric injury in blunt abdominal trauma involves compression and deceleration forces which result in a spectrum of injuries that range from contusions, to tearing of the bowel wall, to shearing of the mesentery, to loss of vascular supply.3-5 Morbidity and mortality due to delayed diagnosis occur as a result of haemorrhage of injured mesenteric vessels and peritonitis from bowel wall rupture or bowel ischaemia. Patients with a slow oozing mesenteric haematoma may remain clinically undetected for days, until bowel necrosis occurs leading to peritonitis. Alternatively, a delayed haemorrhage may occur as a result of relaxation of vasospasm, pressure related displacement of thrombus, or liquefaction of temporary blood clot.The diagnosis of mesenteric injuries tends to be delayed. Early detection and surgical intervention, when necessary, are critic...

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The Mechanism of Intestinal Injury in Trauma

Cited by 107 publications

References 0 publications

Seat-belt Injuries

Seat-belt Injuries

Jejunal Tackle

Mesenteric injury caused by minor blunt abdominal trauma

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