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Description2 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
- 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
- Small bowel is the 2nd most commonly injured organ (32%) in anterior abdominal stabbing.
- Small-bowel injury is most common in gunshot wounds (49%).
- 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.