title: Gastrointestinal tract perforation following blunt abdominal trauma: an institution's experience.
abstract: OBJECTIVE
  Traumatic perforation of the gastrointestinal tract (GIT) poses numerous challenges for surgeons worldwide. We aimed to review our institution's experience and highlight the pertinent issues in managing this problem.
  
  
  METHODS
  A retrospective review was performed for all patients with perforation of the GIT following traumatic blunt injuries.
  
  
  RESULTS
  Twenty-one patients, with a median age of 40 years, formed the study group, all of whom underwent surgery. Four patients were sent straight to the operating theater from the emergency department due to hemodynamic instability, while another two patients had pneumoperitoneum on their X-rays. Computed tomography (CT) scan was performed in 15 patients, with the findings of pneumoperitoneum (n = 7, 46.7%) and free fluid without solid organ injury (n = 9, 60.0%) being the most common result. The jejunum (n = 11, 52.4%) and ileum (n = 5, 23.8%) were the most common sites of perforation. Direct repair was performed in 9 (42.9%) patients, while resection of the perforated segment(s) was performed in the remaining 12 (57.1%) patients. Other associated intra-abdominal injuries included mesenteric (n = 6, 28.6%) and splenic lacerations (n = 4, 19.0%). Surgery was performed within 8 h of the accident in only 11 patients (52.4%). Some of the complications included wound infection (n = 7, 33.3%) and intra-abdominal abscesses (n = 3, 14.3%). Two patients underwent relook laparotomy after an initial damage control laparotomy.
  
  
  CONCLUSIONS
  Prompt and early surgery for traumatic gastrointestinal perforation is advised. Any abnormal CT scans warrants either surgery or close monitoring. Direct repair of the perforation is preferred, if possible.
authors.affiliation: TTSH-NNI Trauma Centre, Tan Tock Seng Hospital, Singapore, Singapore. kerkan@gmail.com.|Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan, Singapore, 308433, Singapore. kerkan@gmail.com.
authors.forename: K-K
authors.initials: KK
authors.lastname: Tan
authors.affiliation: TTSH-NNI Trauma Centre, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: J Z-Y
authors.initials: JZ
authors.lastname: Liu
authors.affiliation: TTSH-NNI Trauma Centre, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: A
authors.initials: A
authors.lastname: Vijayan
authors.affiliation: TTSH-NNI Trauma Centre, Tan Tock Seng Hospital, Singapore, Singapore.
authors.forename: M-T
authors.initials: MT
authors.lastname: Chiu
keywords: Blunt trauma; Gastrointestinal tract; Hollow viscus; Perforation
references.citation: J Trauma. 2000 Aug;49(2):177-87; discussion 187-9
references.pmid: 10963527
references.citation: J Trauma. 2006 Apr;60(4):785-91
references.pmid: 16612298
references.citation: Aust N Z J Surg. 2000 Nov;70(11):795-9
references.pmid: 11147440
references.citation: J Trauma. 1999 May;46(5):920-6
references.pmid: 10338413
references.citation: J Trauma. 1999 Sep;47(3):500-7; discussion 507-8
references.pmid: 10498304
references.citation: J Trauma. 2003 Sep;55(3):399-406
references.pmid: 14501878
references.citation: J Trauma. 2001 Dec;51(6):1054-61
references.pmid: 11740250
references.citation: J Trauma. 1996 Sep;41(3):509-13
references.pmid: 8810972
references.citation: J Trauma. 2002 Jun;52(6):1134-40
references.pmid: 12045643
references.citation: J Trauma. 2000 Mar;48(3):408-14; discussion 414-5
references.pmid: 10744277
references.citation: J Trauma. 1986 Jul;26(7):585-92
references.pmid: 3723633