Blunt abdominal trauma with small bowel injury: are isolated lesions riskier than associated lesions?
OBJECTIVE
The objective of this study was to compare patients with "isolated" blunt small bowel injury (SBI) to patients with multiple intra-abdominal injuries and analyze whether delayed laparotomy affected outcome.


METHODS
Medical records of patients that suffered a blunt SBI between 1994 and 2005 were reviewed. The patients were divided into two groups: those with isolated SBI and those with other associated intra-abdominal injuries ("non-isolated"). The method of diagnosis, time to operation, small bowel Organ Injury Scale (OIS) assessment (grade >or= 2), injury severity score (ISS), morbidity, and mortality were analyzed.


RESULTS
A total of 90 patients met the inclusion criteria, including 62 (68.9%) isolated cases and 28 (31.1%) non-isolated cases. Isolated cases required more supplementary diagnostic methods than the non-isolated cases. Non-isolated cases had a shorter diagnosis to treatment period (p < .01) and a higher ISS (mean 22.5 vs. 17.2 in "isolated" group). Morbidity (51.6% and 53.6%) and mortality (16.1% and 28.6%) did not differ significantly between the isolated and non-isolated groups. Delays in diagnosis were common in the isolated group, but this did not affect outcome. Patients with associated injuries, and higher ISS, had higher mortality.


CONCLUSIONS
The presence of associated intra-abdominal injuries significantly affected the presentation and time to diagnosis of patients with SBI, but not morbidity or mortality. Delayed surgical treatment in the isolated cases was not associated with an increased incidence of complications. Patients inflicted with more severe associated injuries were less likely to survive the trauma.
Fraga
Gustavo Pereira
GP
University of California, San Diego, CA, USA. fragagp@uol.com.br
Silva
Fernando Henrique Bergo de Souza e
FH
Almeida
Nicolle Antunes de
NA
Curi
Jorge Carlos Machado
JC
Mantovani
Mario
M
D000007:Abdominal Injuries / Q000150:complications* / Q000401:mortality / Q000601:surgery; D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D007082:Ileum / Q000293:injuries* / Q000601:surgery; D007583:Jejunum / Q000293:injuries* / Q000601:surgery; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D015599:Trauma Severity Indices; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000401:mortality / Q000601:surgery; D055815:Young Adult