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Small-Bowel Injury

Small-Bowel Injury is a topic covered in the 5-Minute Emergency Consult.

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2 general causes:
  • 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


  • Blunt:
    • 3rd 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 2nd most commonly injured organ (32%) in anterior abdominal stabbing.
    • Small-bowel injury is most common in gunshot wounds (49%).

Pediatric Considerations
  • 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.

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Rosen, Peter, et al., editors. "Small-Bowel Injury." 5-Minute Emergency Consult, 5th ed., Lippincott Williams & Wilkins, 2016. Emergency Central, emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307020/all/Small_Bowel_Injury.
Small-Bowel Injury. In: Rosen P, Shayne P, Barkin AZ, et al, eds. 5-Minute Emergency Consult. 5th ed. Lippincott Williams & Wilkins; 2016. https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307020/all/Small_Bowel_Injury. Accessed April 23, 2019.
Small-Bowel Injury. (2016). In Rosen, P., Shayne, P., Barkin, A. Z., Wolfe, R. E., Hayden, S. R., Barkin, R. M., & Schaider, J. J. (Eds.), 5-Minute Emergency Consult. Available from https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307020/all/Small_Bowel_Injury
Small-Bowel Injury [Internet]. In: Rosen P, Shayne P, Barkin AZ, Wolfe RE, Hayden SR, Barkin RM, Schaider JJ, editors. 5-Minute Emergency Consult. Lippincott Williams & Wilkins; 2016. [cited 2019 April 23]. Available from: https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307020/all/Small_Bowel_Injury.
* Article titles in AMA citation format should be in sentence-case
TY - ELEC T1 - Small-Bowel Injury ID - 307020 ED - Rosen,Peter, ED - Shayne,Philip, ED - Barkin,Adam Z, ED - Wolfe,Richard E, ED - Hayden,Stephen R, ED - Barkin,Roger M, ED - Schaider,Jeffrey J, BT - 5-Minute Emergency Consult UR - https://emergency.unboundmedicine.com/emergency/view/5-Minute_Emergency_Consult/307020/all/Small_Bowel_Injury PB - Lippincott Williams & Wilkins ET - 5 DB - Emergency Central DP - Unbound Medicine ER -