title: Diagnostic and therapeutic challenges of isolated small bowel perforations after blunt abdominal injury in low income settings: analysis of twenty three new cases.
abstract: BACKGROUND
  Isolated small bowel injury (ISBI) related to abdominal blunt trauma is rare. Timely diagnosis could be difficult, especially in the absence of modern imaging and laparoscopic facilities. The determinants of mortality under such circumstances are unclear.
  
  
  METHODS
  This study presents twenty three cases of ISBI related to blunt abdominal injury identified between January 2005 and December 2009 in a level III Hospital in Limbe, Cameroon. Data were retrieved from an ongoing prospective study on injuries and augmented by analysis of individual patient's files. We analysed information regarding modalities of diagnosis, delay between injury and diagnosis, operative findings, treatment and outcome.
  
  
  RESULTS
  The ages of our patients ranged from 7 to 38 years with a mean of 19 years. Thirteen patients were children below the age of 16. The most frequent mechanism of injury was a fall (n=11). Associated lesions were identified in 7 patients. Delay between injury and diagnosis was above 12h in 16 patients. Fifteen cases were admitted with obvious signs of peritonitis. Erect chest X-ray identified a pneumoperitoneum in 11 of the 17 patients for whom it was requested. Most perforations were located in the ileum. A total of 7 complications occurred in 5 patients. These included 4 cases of post-operative peritonitis. Two patients with at least one associated lesion died.
  
  
  CONCLUSIONS
  ISBI is seldom suspected. This causes delay in diagnosis and most cases present with a diffuse peritonitis. Early diagnosis and management in low income environment is likely to be improved by a greater awareness of clinicians about this injury, serial clinical assessment and repeated erect chest X-ray, rather than sophisticated tools such as CT scan or laparoscopy.
authors.affiliation: Faculty of Health Sciences, University of Buea and Regional Hospital, Limbe, Cameroon. Electronic address: alainchichom@yahoo.com.
authors.forename: Alain
authors.initials: A
authors.lastname: Chichom Mefire
authors.forename: Patrick Elroy
authors.initials: PE
authors.lastname: Weledji
authors.forename: Vincent Siysi
authors.initials: VS
authors.lastname: Verla
authors.forename: Nsen Mbuh
authors.initials: NM
authors.lastname: Lidwine
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality; D000293:Adolescent; D000328:Adult; D002163:Cameroon / Q000453:epidemiology; D002648:Child; D002983:Clinical Competence; D057210:Delayed Diagnosis; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data; D006801:Humans; D007416:Intestinal Perforation / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D008297:Male; D010538:Peritonitis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control; D010808:Physical Examination; D010820:Physicians / Q000592:standards*; D011204:Poverty Areas; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D011859:Radiography; D012307:Risk Factors; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000401:mortality
keywords: Abdominal blunt trauma; Delay; Diagnosis; Isolated small bowel injury; Low income setting; Management