Injuries of the small and large intestine
Authors:
J. Rosendorf 1,2; R. Pálek 1,2; H. Mírka 3; V. Třeška 1; V. Liška 1,2
Authors place of work:
Chirurgická klinika Lékařské fakulty v Plzni, Univerzita Karlova
1; Biomedicínské centrum Lékařské fakulty v Plzni, Univerzita Karlova
2; Klinika zobrazovacích metod Lékařské fakulty v Plzni, Univerzita Karlova
3
Published in the journal:
Rozhl. Chir., 2019, roč. 98, č. 8, s. 315-320.
Category:
Původní práce
doi:
https://doi.org/10.33699/PIS.2019.98.8.315–320
Summary
Introduction: Patients with abdominal trauma appear frequently. The most vulnerable organs in these patients are the liver and the spleen. Injuries of the small and large intestines are relatively less frequent. The diagnostic process of these injuries is complex and requires an analysis of all results. Therefore it is highly probable that the final diagnosis can be delayed and so can be delayed an indication of surgical exploration of the abdominal cavity, which can have serious consequences on the morbidity and mortality of these patients with intestinal trauma.
Methods: We collected our data using the WinMedicalc 2000 software. We searched for patients hospitalised in years 2008−2017 in the Department of Surgery, Faculty of Medicine in Pilsen subjected to surgical revision of the abdominal cavity for intestinal trauma.
Results: Our set comprised 41 patients, including 30 men and 11 women. The mean age of the patients was 41 years, 4 of the patients were children. Twenty-three of the patients suffered from polytrauma, while 9 of the patients had a relatively isolated injury of either the small intestine or the colon. Six of the patients died. The small intestine was injured in 17 patients, the colon was injured in 14 patients and both were injured in 10 patients. The intestinal injury was diagnosed in 17 cases based on CT imaging (performed 31 times in total); 23 cases were diagnosed in the peroperative period.
Conclusions: We assessed a set of patients with an intestinal injury in terms of specific diagnosis, severity of trauma, diagnostic process and treatment. The results are similar to the results of studies in large sets of patients. Even though imaging methods can help to reach the right diagnosis, they are insufficient as a sole diagnostic method, and physical examination plays a major role.
Keywords:
diagnosis – abdominal trauma – intestinal injury – bowel injury – polytrauma
Zdroje
- Haagsma JA, Graetz N, Bolliger I, et al. The global burden of injury: incidence, mortality, disability-adjusted life years and time trends from the Global burden of disease study 2013. Injury Prevention 2016;22:3−18. doi: 10.1136/injuryprev-2015-041616.
- Iaselli F, Mazzei MA, Firetto C, et al. Bowel and mesenteric injuries from blunt abdominal trauma: a review. Radiol Med. 2015;120:21−32. doi: 10.1007/s11547-014-0487-8.
- Dai LN, Chen CD, Lin XK, et al. Abdominal injuries involving bicycle handlebars in 219 children: results of 8-year follow-up. Eur J Trauma Emerg Surg. 2015;41:551−5.
- Klin B, Efrati Y, Vaiman M, et al. Abdominal injuries following bicycle-related blunt abdominal trauma in children. Minerva Pediatr. 2016;68:167−72.
- Gamanagatti S, Rangarajan K, Kumar A, et al. Blunt abdominal trauma: imaging and intervention. Curr Probl Diagn Radiol. 2015;44:321−36. doi: 10.1067/j.cpradiol.2015.02.005.
- Vailas MG, Moris D, Orfanos S, et al. Seatbelt sign in a case of blunt abdominal trauma; what lies beneath it? BMC Surg. 2015;30:121. doi: 10.1186/s12893-015-0108-z.
- Malinoski DJ, Patel MS, Yakar DO, et al. A diagnostic delay of 5 hours increases the risk of death after blunt hollow viscus injury. J Trauma. 2010;69:84−7. doi: 10.1097/TA.0b013e3181db37f5.
- Savatmongkorngul S, Wongwaisayawan S, Kaewlai R. Focused assessment with sonography for trauma: current perspectives. Open Access Emerg Med. 2017;26;9:57−62. doi: 10.2147/OAEM.S120145.
- Carter JW, Falco MH, Chopko MS, et al. Do we really rely on fast for decision-making in the management of blunt abdominal trauma? Injury 2015;46:817−21. doi: 10.1016/j.injury.2014.11.023.
- Young K, Benson M, Higgins A, et al. In the modern era of CT, do blunt trauma patients with markers for blunt bowel or mesenteric injury still require exploratory laparotomy? Am Surg. 2017;83:722−7.
- Fakhry SM, Brownstein M, Watts DD, et al. Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience. J Trauma. 2000;48:408−14; discussion 414−5.
- Choi WJ. Management of colorectal trauma. J Korean Soc Coloproctol. 2011;27:166−72. doi: 10.3393/jksc.2011.27.4.166.
- Raharimanantsoa M, Zingg T, Thiery A, et al. Proposal of a new preliminary scoring tool for early identification of significant blunt bowel and mesenteric injuries in patients at risk after road traffic crashes. Eur J Trauma Emerg Surg. 2018;44:779−85.
- Barbieux J, Plumereau F, Hamy A. Current indications for the Hartmann procedure. J Visc Surg. 2016;153:31−8. doi: 10.1016/j.jviscsurg.2016.01.002.
- Naumann DN, Vincent LE, Pearson N, et al. An adapted Clavien-Dindo scoring system in trauma as a clinically meaningful nonmortality endpoint. J Trauma Acute Care Surg. 2017;83:241−8. doi: 10.1097/TA.0000000000001517.
- Schonfeld D, Lee LK. Blunt abdominal trauma in children. Curr Opin Pediatr. 2012;24:314−8.
- Hagel BE, Romanow NTR, Enns N, et al. Severe bicycling injury risk factors in children and adolescents: a case-control study. Accid Anal Prev. 2015;78:165−72.
- Holland AJ, Soundappan SS. Trauma hazards in children: An update for the busy clinician. J Paediatr Child Health. 2017;53:1096−1100.
- Cheong JY, Keshava A. Management of colorectal trauma: a review. ANZ J Surg. 2017;87:547−53. doi.org/10.1111/ans.13908.
- Chereau N, Wagner M, Tresallet C, et al. CT scan and diagnostic peritoneal lavage: towards a better diagnosis in the area of nonoperative management of blunt abdominal trauma. Injury 2016;47:2006−11. doi: 10.1016/j.injury.2016.04.034.
- Wang YC, Hsieh CH, Fu CY, et al. Hollow organ perforation in blunt abdominal trauma: the role of diagnostic peritoneal lavage. Am J Emerg Med. 2012;30:570−3. doi: 10.1016/j.ajem.2011.02.014.
- Hoch J, Jech Z, Mikulenka V. Poranění střeva. Prakt Lék. 2000:217−9.
- Treska V, Kasal E, Stransky P a kol. Traumatologie břicha a retroperitonea 2013.
- Zingg T, Agri F, Bourgeat M, et al. Avoiding delayed diagnosis of significant blunt bowel and mesenteric injuries: Can a scoring tool make the difference? A 7-year retrospective cohort study. Injury 2018;49:33−41. doi.org/10.1016/j.injury.2017.09.004.
- P. Chmátal, P. Kupka, V. Vlasák, et al. Opožděné laparotomie u tupých úrazů břicha: výskyt, příčiny, mortalita a doba hospitalizace v souboru 139 operovaných pacientů. Retrospektivní studie. Rozhl Chir. 2006;85:59−63.
Štítky
Chirurgia všeobecná Ortopédia Urgentná medicínaČlánok vyšiel v časopise
Rozhledy v chirurgii
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