THE MANAGEMENT OF SMALL BOWEL AND MESENTERIC INJURIES IN BLUNT ABDOMINAL TRAUMA: LATE DOES NOT MEAN WORSE

Introduction: Blunt traumatic injuries to small bowel (SB) and its mesentery could be misdiagnosed. Specific symptoms due to perforation and/or ischaemia may develop hours after trauma. Associated abdominal injuries may represent a confounding factor but also mandate surgery through an early diagnosis of SB trauma is cleared. Aim of this study was to detect if a delayed diagnosis of SB blunt trauma may worsen the surgical outcome. Material and methods: We reviewed 43 patients undergone surgery for SB and mesenteric blunt trauma. Two groups were identified. Group A included 35 patients (69 %) in which SB/mesenteric injuries were recognized and fixed within 12 hrs from admission. of these, 19 pts had immediate laparotomy for hemoperitoneum and shock due to severe multiple abdominal injuries and SB injuries were diagnosed occasionally. Group B included 8 patients (31 %) with isolated SB injuries in which diagnosis and surgery was accomplished more than 12 hrs from admission. Results: Group A patients presented with higher OIS grades. Among these 19 patients had multiple abdominal injuries and 16 of them had isolated SB injuries. Morbidity (34 % group A; 25 % group B, p[0.01) and mortality (14 % group A, nihil group B, p\0.01) were lower in Group B. However, no fatality was related to the SB trauma itself. Conclusion: In blunt abdominal trauma, the presence of multiple severe abdominal injuries requiring laparotomy makes possible a prompt diagnosis of SB/mesenteric lesions. When injuries are isolated, a delay in diagnosis and surgery could be expected. In these circumstances however late surgery does not seem to affect the outcome.