Gastrointestinal tract perforation following blunt abdominal trauma: an institution’s experience

Published in European Journal of Trauma and Emergency Surgery on 4 May 2011

K.K. Tan, J.Z.Y. Liu, A. Vijayan, M.T. Chiu
TTSH-NNI Trauma Centre, Department of General Surgery, Tan Tock Seng Hospital, Singapore

Abstract

Purpose

Traumatic perforation of the gastrointestinal tract (GIT) poses numerous challenges for surgeons worldwide. We aimed to review our institution’s experience and highlight the pertinent issues in managing this problem.

Methods

A retrospective review was performed for all patients with perforation of the GIT following traumatic blunt injuries.

Results

Twenty-one patients, with a median age of 40 years, formed the study group, all of whom underwent surgery. Four patients were sent straight to the operating theater from the emergency department due to hemodynamic instability, while another two patients had pneumoperitoneum on their X-rays. Computed tomography (CT) scan was performed in 15 patients, with the findings of pneumoperitoneum (n = 7, 46.7%) and free fluid without solid organ injury (n = 9, 60.0%) being the most common result. The jejunum (n = 11, 52.4%) and ileum (n = 5, 23.8%) were the most common sites of perforation. Direct repair was performed in 9 (42.9%) patients, while resection of the perforated segment(s) was performed in the remaining 12 (57.1%) patients. Other associated intraabdominal injuries included mesenteric (n = 6, 28.6%) and splenic lacerations (n = 4, 19.0%). Surgery was performed within 8 h of the accident in only 11 patients (52.4%). Some of the complications included wound infection (n = 7, 33.3%) and intra-abdominal abscesses (n = 3,14.3%). Two patients underwent relook laparotomy after an initial damage control laparotomy.

Conclusion

Prompt and early surgery for traumatic gastrointestinal perforation is advised. Any abnormal CT scans warrants either surgery or close monitoring. Direct repair of the perforation is preferred, if possible.

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