Small-Bowel Injury

Basics

Description

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

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%)

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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