title: Delayed Presentations of Blunt Mesenteric and Intestinal Trauma in the Wake of Injury.
abstract: OBJECTIVE
  To analyze the presentation and timing of blunt mesenteric and intestinal trauma requiring surgical intervention.
  
  
  METHODS
  The Hadassah-Hebrew University trauma registry was scanned for patients who required surgery following blunt mesenteric and/or bowel trauma. Demographic data, mechanism of injury, time to diagnosis and pathology reports were recorded. A literature search was also performed.
  
  
  RESULTS
  The majority of patients were injured in motor vehicle accidents (26/30, 86.7%). Patients were divided into three groups. Seventeen patients diagnosed within 4 h of admission were defined as the immediate group. Indication for surgery was hemodynamic instability and/or peritonitis. The most commonly injured region was the terminal ileum (10/17 patients, 59%). The second group (n = 4) had surgery within 2 weeks of injury (early group). These patients presented initially with hemodynamic instability. The operative findings were consistent with a low-flow state of the terminal ileum and cecum. The third group (n = 9) consisted of patients who were operated later than 2 weeks from the date of injury (late group). These patients presented with prolonged abdominal symptoms, chiefly partial small bowel obstruction. Operative findings were bowel strictures, most commonly of the terminal ileum (7/9 patients, 77.8%).
  
  
  CONCLUSIONS
  Acceleration-deceleration abdominal injury affects the terminal ileum more commonly. We propose that the ensuing clinical picture depends on the level of energy transmitted: high-energy trauma leads to extensive mesenteric and bowel tears and is diagnosed immediately. Low-energy trauma may lead to chronic ischemia, fibrosis and stricture-formation. The right colon appears to be more vulnerable to lowflow states following blunt trauma.
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Edden
authors.initials: E
authors.lastname: Yair
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Bala
authors.initials: B
authors.lastname: Miklosh
authors.affiliation: Department of Pathology, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Pappo
authors.initials: P
authors.lastname: Orit
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University, Jerusalem, Israel.
authors.forename: Rivkind
authors.initials: R
authors.lastname: Avraham
authors.affiliation: Department of General Surgery, Hadassah-Hebrew University, Jerusalem, Israel. almogyg@yahoo.com.|Department of Surgery, Hadassah-Hebrew University, 12000, 91120, Jerusalem, Israel. almogyg@yahoo.com.
authors.forename: Almogy
authors.initials: A
authors.lastname: Gidon
keywords: Abdominal trauma; Multiple trauma; Polytrauma managment including pre-hospital and shockroom