Introduction: Blunt small bowel and mesentery injuries (BBMI) can be detected in 1.2-5% of patients with blunt abdominal trauma. Delay in the diagnosis of BBMI can increase morbidity and mortality. CT scan is the gold standard for the diagnostic evaluation of BBMI in the hemodynamically stable patients. Aim of this study is to evaluate clinical and radiological data of patients undergone surgery for BBMI, in order to assess retrospectively the diagnostic accuracy of CT. Material & Methods: We reviewed the charts of the patients admitted to a first level emergency department during the period 2002–2018 in which BBMI was confirmed at surgical exploration. Patients’’ demographics, hemodynamical status, injury severity score (ISS), primary site of intestinal lesion, injury organ scale (OIS), timing of surgery from the admission, CT findings and mortality were analyzed. CT findings were reported as a) highly suggestive, for BBMI in presence of pneumoperitoneum with radiological evidence of intestinal wall/mesenteric injury; b)suspicious, in case of free intraperitoneal fluid without evidence of injuries of the wall and/or the mesentery, and c)negative, in absence of any of the previous described signs. Results: 55 patients. 16 of whom (29%) unstable were included in the study. Mean ISS was 22 (range 8-50). Site of bowel injury was mesentery in 44 cases (80%), jejunum in 6 (11%) and ileum in 5 (10%). Mean OIS was III. Abdominal CT scan resulted highly suggestive for BBMI in 16 (47%) patients, suspicious in 17 (50%) and negative in 1 (3%). In the later two groups, surgery was offered with a delay exceeding 12 hours in 8 patients (44%).The overall mortality was 18% (10 cases). No death was related to BBMI even in the cases in which surgery had been delayed. Conclusions: BBMI remain a most difficult diagnosis when a laparotomy for concomitant abdominal injuries is not mandatory. Abdominal CT may be unable to prove highly suggestive findings in more than half of patients harboring BBMI. For this reason suspicion signs should not be missed and should prompt a careful clinical observation. From this report, a delay in surgical exploration does not seem to affect mortality.

BLUNT TRAUMATIC SMALL BOWEL AND MESENTERIC INJURIES –A CAREFUL INTERPRETATION OF ABDOMINAL CT FINDINGS HELPS TO AVOID A DELAYED TREATMENT

R. Fantacci;S. Strambi;D. Tartaglia;L. Cobuccio;A. Bertolucci;I. Cengeli;M. Chiarugi
2019-01-01

Abstract

Introduction: Blunt small bowel and mesentery injuries (BBMI) can be detected in 1.2-5% of patients with blunt abdominal trauma. Delay in the diagnosis of BBMI can increase morbidity and mortality. CT scan is the gold standard for the diagnostic evaluation of BBMI in the hemodynamically stable patients. Aim of this study is to evaluate clinical and radiological data of patients undergone surgery for BBMI, in order to assess retrospectively the diagnostic accuracy of CT. Material & Methods: We reviewed the charts of the patients admitted to a first level emergency department during the period 2002–2018 in which BBMI was confirmed at surgical exploration. Patients’’ demographics, hemodynamical status, injury severity score (ISS), primary site of intestinal lesion, injury organ scale (OIS), timing of surgery from the admission, CT findings and mortality were analyzed. CT findings were reported as a) highly suggestive, for BBMI in presence of pneumoperitoneum with radiological evidence of intestinal wall/mesenteric injury; b)suspicious, in case of free intraperitoneal fluid without evidence of injuries of the wall and/or the mesentery, and c)negative, in absence of any of the previous described signs. Results: 55 patients. 16 of whom (29%) unstable were included in the study. Mean ISS was 22 (range 8-50). Site of bowel injury was mesentery in 44 cases (80%), jejunum in 6 (11%) and ileum in 5 (10%). Mean OIS was III. Abdominal CT scan resulted highly suggestive for BBMI in 16 (47%) patients, suspicious in 17 (50%) and negative in 1 (3%). In the later two groups, surgery was offered with a delay exceeding 12 hours in 8 patients (44%).The overall mortality was 18% (10 cases). No death was related to BBMI even in the cases in which surgery had been delayed. Conclusions: BBMI remain a most difficult diagnosis when a laparotomy for concomitant abdominal injuries is not mandatory. Abdominal CT may be unable to prove highly suggestive findings in more than half of patients harboring BBMI. For this reason suspicion signs should not be missed and should prompt a careful clinical observation. From this report, a delay in surgical exploration does not seem to affect mortality.
2019
https://doi.org/10.1007/s00068-019-01109-1
File in questo prodotto:
Non ci sono file associati a questo prodotto.

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11568/990420
 Attenzione

Attenzione! I dati visualizzati non sono stati sottoposti a validazione da parte dell'ateneo

Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus ND
  • ???jsp.display-item.citation.isi??? ND
social impact