ABSTRACT
Introduction Bowel perforation, whether from trauma or other causes, presents with diverse clinical scenarios. Small bowel perforation (SBP), a potentially fatal condition often linked to blunt trauma like motor vehicle accidents, necessitates prompt detection and intervention, crucial for improved outcomes. This study investigated the prevalence, predictors, presentation, diagnostic findings, morbidity, and mortality of traumatic SBP for comprehensive insights. Methodology This was a retrospective cohort study conducted at King Abdulaziz Medical City, Riyadh. A review of 838 cases, which represent all abdominal trauma patients from January 2017 to March 2023, was done. Forty patients who developed SBP and have complete data were included in this study. One case was excluded due to incomplete medical records. Data were collected with the non-probability convenience sampling technique via the BestCare system using a data collection sheet. Data were analyzed with IBM SPSS 29 (IBM Corp., Armonk, NY). Results Out of all abdominal trauma cases (n=838), 40 patients developed SBP (n=40, 4.77%). Males constituted 87.5%, and the most common mechanism was motor vehicle accidents (57.5%). Complications included cardiac arrest, disseminated intravascular coagulation (DIC), and leak (7.5% each). In motor vehicle accidents, SBP primarily affected patients who were in the driver's position (78.3%). Clinical signs at presentation revealed abdominal tenderness (52.5%), abdominal distension (22.5%), and abnormal systolic blood pressure (mean 115.3 mmHg). Linear regression showed gender and age positively associated with morbidity (p=0.474, p=0.543) while BMI exhibited a negative relationship (p=0.314). Logistic regression revealed non-significant predictors of mortality, except for mean initial hematocrit (HCT) (p=0.721, aOR=0.098). Conclusion Our study provides crucial findings on the incidence, patterns, mortality, and morbidity of traumatic bowel perforation, contributing to the existing body of research. The identified prevalence of 4.77% and mortality at 17.5% from the studied population underline the serious impact of this condition, and the 37.5% complication rate observed demonstrates the potential risks involved. The average hospital stay is found to be 14 days, adding further to the disease burden. These findings underscore the importance of specific preventative measures, particularly related to motor vehicle accidents (MVAs), and highlight potential markers for predicting outcomes, such as age, gender, and mean initial HCT. This substantiates the need for further research involving larger cohorts and prospective designs to gain comprehensive insights and establish more robust preventative and treatment strategies.
ABSTRACT
Isolated duodenal transection-a rare complication of abdominal trauma-is a challenging dilemma and difficult to diagnose. As blunt duodenal injuries vary from mild hematoma or perforation to complete transection or complex pancreaticoduodenal disruption. A 21-year-old male medically free victim of motor vehicle collision was admitted to our hospital and evaluated in ER according to ATLS protocol. Patient was stable with positive fast scan so we proceeded for abdomen computed tomography, which showed duodenal injury with possible pancreatic transection and active arterial extravasation. Based on that patient was taken for exploratory laparotomy and primary repair. Duodenal injuries can be a result of different mechanism. Typically, it was the result of crush injury, however, it can be due to shear or bursting forces. With its anatomical location, reaching the accurate diagnosis might be delayed, which is associated with higher mortality rate. Due to different scales of severity and different presentation, the management varies based on the location and the involved surrounding structures. Although complete duodenal transection is rare with blunt injuries, high clinical suspicion is necessary to detect such injury early. Studies have shown that the outcomes are highly dictated by early diagnosis and prompt management.
