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Alsayali MM, Atkin C, Winnett J, et al. Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital. Eur J Trauma Emerg Surg. 2009;35(5):482doi: 10.1007/s00068-009-8078-4.
Alsayali, M. M., Atkin, C., Winnett, J., Rahim, R., Niggemeyer, L. E., & Kossmann, T. (2009). Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital. European journal of trauma and emergency surgery : official publication of the European Trauma Society, 35(5), 482. https://doi.org/10.1007/s00068-009-8078-4
Alsayali, Mashal M, et al. "Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital." European journal of trauma and emergency surgery : official publication of the European Trauma Society vol. 35,5 (2009): 482. doi: https://doi.org/10.1007/s00068-009-8078-4
Alsayali MM, Atkin C, Winnett J, Rahim R, Niggemeyer LE, Kossmann T. Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital. Eur J Trauma Emerg Surg. 2009 Oct;35(5):482. doi: 10.1007/s00068-009-8078-4. Epub 2009 Jul 04. PMID: 26815216.
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Eur J Trauma Emerg Surg. 2009 Oct;35(5):482. doi: 10.1007/s00068-009-8078-4. Epub 2009 Jul 04.

Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital.

European journal of trauma and emergency surgery : official publication of the European Trauma Society

Mashal M Alsayali, Chris Atkin, Jason Winnett, Reza Rahim, Louise E Niggemeyer, Thomas Kossmann

Affiliations

  1. Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia. [email protected].
  2. National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia. [email protected].
  3. Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia.
  4. National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
  5. Department of Surgery, Monash University, Melbourne, Australia.

PMID: 26815216 DOI: 10.1007/s00068-009-8078-4

Abstract

BACKGROUND: The incidence of blunt bowel and mesenteric injury (BBMI) has increased recently in blunt abdominal trauma, possibly due to an increasing number of high-speed motor accidents and the use of seat belts.

OBJECTIVE: Our aim was to identify the factors determining the time of surgical intervention and how they affect the outcome of the patient with BBMI. This was achieved by reviewing our experience as a major Victorian trauma service in the management of bowel and mesenteric injuries and comparing this to the experiences reported in the literature.

METHODS: A retrospective study reviewing 278 consecutive patients who presented to the Alfred trauma center with blunt bowel and mesenteric injuries over a 6-year period.

RESULTS: The patient cohort comprised 278 patients with BBMI (66% were male, 34% were female), of whom 80% underwent a laparotomy, 17% were treated conservatively and 3% were diagnosed post-mortem. In terms of time from admission to laparotomy, 67% were treated within 0-4 h, 9% within 4-8 h, 3% within 8-12 h, 10% within 12-24 h, 4% within 24-48 h and 7% at >48 h. A focused abdominal sonography for trauma (FAST) was performed in 86 patients, of whom 51% had a positive FAST, 44% had a negative FAST and 4% had an equivocal FAST. Overall, 13% of the patient cohort did not have a FAST. Computerized tomography (CT) scans were undertaken preoperatively in 68% of the patients, revealing free gas (22% of patients), bowel-wall thickening (31%), fat and mesenteric stranding or hematoma (38%) and free fluid with no solid organ injury (43%).

CONCLUSION: The timing of surgical intervention in cases of BBMI is mostly determined by the clinical examination and the results of the helical CT scan findings. The FAST lacks sensitivity and specificity for identifying bowel and mesenteric trauma. A delayed diagnosis of > 48 h has a significantly higher bowelrelated morbidity but not mortality.

Keywords: Blunt abdominal trauma; CT scan; Delay in diagnosis; Diagnosis; Trauma

References

  1. Radiographics. 2006 Jul-Aug;26(4):1119-31 - PubMed
  2. Radiology. 1999 May;211(2):399-403 - PubMed
  3. J Trauma. 2000 Mar;48(3):402-7 - PubMed
  4. Am Surg. 1997 Oct;63(10):885-8 - PubMed
  5. Radiat Med. 2006 Jun;24(5):358-64 - PubMed
  6. J Trauma. 2002 Jul;53(1):79-85 - PubMed
  7. J Trauma. 2004 Oct;57(4):739-41 - PubMed
  8. Acad Emerg Med. 2005 Sep;12(9):808-13 - PubMed
  9. Injury. 2002 Sep;33(7):617-26 - PubMed
  10. Am J Emerg Med. 2006 Jan;24(1):19-24 - PubMed
  11. AJR Am J Roentgenol. 1997 Feb;168(2):425-8 - PubMed
  12. J Trauma. 2005 Apr;58(4):696-701; discussion 701-3 - PubMed
  13. J Trauma. 2000 Mar;48(3):408-14; discussion 414-5 - PubMed
  14. Br J Surg. 2005 Aug;92 (8):1024-8 - PubMed
  15. Eur J Surg. 2001 Feb;167(2):106-9 - PubMed
  16. J Trauma. 2003 Feb;54(2):289-94 - PubMed
  17. Radiology. 2004 Dec;233(3):689-94 - PubMed
  18. J Trauma. 2000 Oct;49(4):606-10 - PubMed
  19. Eur J Radiol. 2004 Apr;50(1):67-73 - PubMed

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