The pathophysiology and management of bowel and mesenteric injuries due to blunt trauma

Abstract

Historical accounts of small bowel injuries from blunt abdominal trauma are numerous and date from as early as Aristotle in 350 b.c. [1,2]. The majority of reports of gastrointestinal tract injuries (GITIs) relate experiences dominated by penetrating trauma. Injuries to the gastrointestinal tract resulting from penetrating trauma are common, with 80% of gunshot wounds to the abdomen and 30% of fully penetrating stab wounds causing significant injury to the GIT [3–5]. GITIs are much less common following blunt trauma. There are few reports in the literature which describe reports of the management and outcome from these injuries [6–14]. Nevertheless, the GIT is the third most commonly injured abdominal organ in blunt trauma [6,15–17] with major GITIs found in 5–17% of laparotomies for blunt trauma [7,9,16,18–24] and 0.35–2% of blunt trauma admissions having a major GITI [9,15,23,25,26]. The incidence of GITIs rose steeply with the introduction of high speed travel after World War II [16,27] and was then documented to increase further with the introduction of seat belts [15]. The mechanism involved with seat belts is believed to be the creation of closed loops of bowel as a result of compression and subsequent rupture from increased intraluminal pressure [7,15,16]. Blunt GITIs are undoubtedly injuries of young males [6,8,10,12,19,20,22,25,8–31]. The incidence of major blunt GITIs amongst paediatric admissions for blunt abdominal trauma has been reported to be greater than for adults [32–34]. Motor vehicle occupants account for rates of 70–85% of patients with major GITIs [6,10,12,19,30,34,35]. In such cases, the rapid deceleration results in multiple serious injuries. The reported incidence of non-vehicular blunt trauma as a cause of GITI is 5–32% [6,9,10,19,36]. Non-vehicular trauma includes assaults, falls, industrial accidents, blasts,