Small-Bowel Injury

Description

• Blunt visceral trauma
• Penetrating: Visceral injury (96% of gunshot wounds, 50% of stabbings) – serosal tear, bowel wall hematoma, perforation, bowel transection, mesenteric hematoma/vascular injury

Etiology

• Blunt:
  • Third most commonly injured organ (5–10% of all blunt trauma victims)
  • Motor vehicle accidents
  • Nonvehicular trauma: Abuse/assault, bicycle handlebars, large-animal kick
  • Blast victims
• Mortality rate from small-bowel injury is 33%
• Mesenteric tears may initially be asymptomatic:
  • Deceleration injury at fixed points (e.g., ligament of Treitz)
  • Shearing mechanisms near fixed points (e.g., ileocecal junction, adhesions)
  • Compressive force against anterior spine
  • Bursting or “blowout” at antimesenteric margin from sudden closed-loop intraluminal pressure rise
• Associated injuries:
  • Liver and splenic lacerations; thoracic and pelvic fractures
  • Seatbelt syndrome: Abdominal wall ecchymosis, small-bowel injury; Chance fracture of L1, L3
• Penetrating:
  • Small bowel is the second most commonly injured organ (32%) in anterior abdominal stabbing
  • Small-bowel injury is most common in gunshot wounds (49%)

• Blunt:
  • Less common in children (1–8% of all blunt pediatric trauma)
  • Lower chance of intestinal injury in vehicular accidents when both shoulder and lap belts are worn
  • Be cautious of nonpenetrating trauma: Airgun accidents at close range (<10 ft)
  • Consider the possibility of nonaccidental trauma