title: Management of blunt bowel and mesenteric injuries: Experience at the Alfred hospital.
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%).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia. abuosamah123@hotmail.com.|National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia. abuosamah123@hotmail.com.|Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia. abuosamah123@hotmail.com.
authors.forename: Mashal M
authors.initials: MM
authors.lastname: Alsayali
authors.affiliation: Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Chris
authors.initials: C
authors.lastname: Atkin
authors.affiliation: Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Jason
authors.initials: J
authors.lastname: Winnett
authors.affiliation: Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia.
authors.forename: Reza
authors.initials: R
authors.lastname: Rahim
authors.affiliation: Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia.|National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
authors.forename: Louise E
authors.initials: LE
authors.lastname: Niggemeyer
authors.affiliation: Department of Trauma Surgery, The Alfred Hospital, Melbourne, Australia.|Department of Surgery, Monash University, Melbourne, Australia.|National Trauma Research Institute, The Alfred Hospital, Melbourne, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kossmann
keywords: Blunt abdominal trauma; CT scan; Delay in diagnosis; Diagnosis; Trauma
references.citation: Radiographics. 2006 Jul-Aug;26(4):1119-31
references.pmid: 16844935
references.citation: Radiology. 1999 May;211(2):399-403
references.pmid: 10228520
references.citation: J Trauma. 2000 Mar;48(3):402-7
references.pmid: 10744276
references.citation: Am Surg. 1997 Oct;63(10):885-8
references.pmid: 9322665
references.citation: Radiat Med. 2006 Jun;24(5):358-64
references.pmid: 16958414
references.citation: J Trauma. 2002 Jul;53(1):79-85
references.pmid: 12131394
references.citation: J Trauma. 2004 Oct;57(4):739-41
references.pmid: 15514526
references.citation: Acad Emerg Med. 2005 Sep;12(9):808-13
references.pmid: 16141013
references.citation: Injury. 2002 Sep;33(7):617-26
references.pmid: 12208066
references.citation: Am J Emerg Med. 2006 Jan;24(1):19-24
references.pmid: 16338504
references.citation: AJR Am J Roentgenol. 1997 Feb;168(2):425-8
references.pmid: 9016219
references.citation: J Trauma. 2005 Apr;58(4):696-701; discussion 701-3
references.pmid: 15824644
references.citation: J Trauma. 2000 Mar;48(3):408-14; discussion 414-5
references.pmid: 10744277
references.citation: Br J Surg. 2005 Aug;92 (8):1024-8
references.pmid: 15931660
references.citation: Eur J Surg. 2001 Feb;167(2):106-9
references.pmid: 11266248
references.citation: J Trauma. 2003 Feb;54(2):289-94
references.pmid: 12579054
references.citation: Radiology. 2004 Dec;233(3):689-94
references.pmid: 15516605
references.citation: J Trauma. 2000 Oct;49(4):606-10
references.pmid: 11038076
references.citation: Eur J Radiol. 2004 Apr;50(1):67-73
references.pmid: 15093237