Abstract
BackgroundThe purpose of the study was to evaluate the impact of emergency laparotomy (EL) on outcomes of patients who suffered from small bowel perforations following a penetrating mechanism and presented with initial systolic blood pressure (SBP) <90 mmHg.MethodsData from 2012-2014 from the National Trauma Data Bank (NTDB) data set was accessed for this study. All patients who presented with initial SBP <90 mmHg and sustained perforated small bowel injury after a penetrating mechanism and were taken for EL within four hours of the patient’s arrival to the hospital were included in the study. Data were categorized into early group, if the EL was performed within an hour and late group, and if EL was done 1-4 hours of patient arrival to the hospital.ResultsOut of 360, approximately 89% of patients underwent EL within an hour and 11% of patients underwent EL within 1-4 hours of hospital arrival. The median (IQR) time of the late laparotomy was two (2, 3) hours. After propensity matching, there were no significance differences found between the groups regarding in-hospital mortality (11 (26.8%) vs 8 (19.5%), P = 0.54), total hospital length of stay (median and IQR 20 (17, 25) vs 15 (11, 20), P = 0.117), discharge to home without services (67% vs. 82%, P = 0.28), and post-operative complications.ConclusionEL in perforated small bowel injury in unstable patients needs to be performed as soon as possible. EL performed within the median of two hours’ time may be acceptable in certain circumstances.
Highlights
Small bowel injury (SBI) is one of the most common abdominal injuries following a penetrating mechanism and occurs in about 50% of patients, followed by colon and solid organ injuries [1]
Data were categorized into early group, if the emergency laparotomy (EL) was performed within an hour and late group, and if EL was done 1-4 hours of patient arrival to the hospital
There were no significance differences found between the groups regarding in-hospital mortality (11 (26.8%) vs 8 (19.5%), P = 0.54), total hospital length of stay (median and interquartile range (IQR) 20 (17, 25) vs 15 (11, 20), P = 0.117), discharge to home without services (67% vs. 82%, P = 0.28), and post-operative complications
Summary
Small bowel injury (SBI) is one of the most common abdominal injuries following a penetrating mechanism and occurs in about 50% of patients, followed by colon and solid organ injuries [1]. The distance, trajectory, and caliber of a bullet can lead to small bowel injury but can be associated with other intra-abdominal injuries, such as liver, spleen, and vascular injury [2]. These associated abdominal injuries can occur with stab wounds and other impaled objects. The purpose of the study was to evaluate the impact of emergency laparotomy (EL) on outcomes of patients who suffered from small bowel perforations following a penetrating mechanism and presented with initial systolic blood pressure (SBP)
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