Clinical Aspects and Prognostic Factors Of Small Bowel Perforation After Blunt Abdominal Trauma

PURPOSE: The incidence of abdominal trauma with intra-abdominal organ injury or bowel rupture is increasing. Articles on the diagnosis, symptoms and treatment of small bowel perforation due to blunt trauma have been reported, but reports on the relationship of mortality and morbidity to clinical factors for prognosis are minimal. The purposes of this study are to evaluate the morbidity and mortality of patients with small bowel perforation after blunt abdominal trauma on the basis of clinical examinationand to analyze factors associated with the prognosisfor blunt abdominal trauma with small bowel perforation. METHODS: The clinical data on patients with small bowel perforation due to blunt trauma who underwent emergency surgery from January 1994 to December 2009 were retrospectively analyzed. The correlation of each prognostic factor to morbidity and mortality, and the relationship among prognostic factors were analyzed. RESULTS: A total of 83 patients met the inclusion criteria: The malewas 81.9% .The mean age was 45.6 years.The mean APACHE II score was 5.75.The mean time interval between injury and surgery was 395.9 minutes.The mean surgery time was 111.1 minutes. Forty seven patients had surgery for ileal perforations, and primary closure was done for 51patients. The mean admission period was 15.3 days, and the mean fasting time was 4.5 days. There were 6 deaths (7.2%), and 25 patientssuffered from complications. CONCLUSION: The patient's age and the APACHE II score on admission were important prognostic factors that effecteda patient's progress. Especially, this study shows that the APACHE II score had effect on the operation time, admission period, the treatment period, the fasting time, the mortality rate, and the complication rate.

Giant Benign Schwannoma Involving Sacral Bone

Sacral schwannoma is a rare lesion with a tendency to reach large proportions. The benign schwannoma rarely involves the vertebral bodies extensively. The authors report a case of giant intrasacral schwannoma in 30-year-old woman who had intermittent lower back pain during 3 years period. CT and MRI showed a destructive mass lesion within the upper part of sacrum with a large mass extending into the presacral space. The patient underwent combined surgery consisted of anterior transabdominal approach and posterior sacral laminectomy and total removal of tumor. The characteristics of the lesion were discussed with a review of literatures.