Gastrointestinal Injuries from Blunt Abdominal Trauma

ABSTRACT

Hollow visceral injuries are far less commom in blunt abdominal trauma than in penetrating abdominal trauma. From June 1994 to Sep. 1996, we treated 46 patients with blunt injuries to the gut, defined as perforation or devascularization. Thirty five patients(76.1%) were injured in motor vehicle collisions. Of these, 22 were not using constraints; 13 were wearing seat belts. Small bowel injuries were the most frequent injuries, followed by colonic injuries, duodenal injuries, rectal injury and gastric perforation. Mortality rates were the lowest in small bowel injuries(11.1%) and higher in less common colonic(22.2%) and duodenal(20.0%) injuries. Except for those patients with perforations of the small bowel, most patients had associated injuries to the head, chest or abdominal solid organs that were largely responsible for morbidity and mortality. Injuries to the abdominal hollow viscera are unusual following blunt trauma, but are the result of very high energy truncal trauma and are associated with multiple additional injuries. Most alert patients had physical findings suggestive of peritoneal irritation, but when diagnostic testing was necessary, peritoneal lavage was superior to CT scanning ( false negative=10.5% versus 88.5% respectively). A high index of suspicion is necessary to avoid diagnostic delays that can lead to severe complications and death.