Blunt traumatic small bowel rupture: are children different?

Diagnostic and therapeutic challenges of isolated small bowel perforations after blunt abdominal injury in low income settings: analysis of twenty three new cases

BACKGROUND

Isolated small bowel injury (ISBI) related to abdominal blunt trauma is rare. Timely diagnosis could be difficult, especially in the absence of modern imaging and laparoscopic facilities. The determinants of mortality under such circumstances are unclear.

METHODS

This study presents twenty three cases of ISBI related to blunt abdominal injury identified between January 2005 and December 2009 in a level III Hospital in Limbe, Cameroon. Data were retrieved from an ongoing prospective study on injuries and augmented by analysis of individual patient's files. We analysed information regarding modalities of diagnosis, delay between injury and diagnosis, operative findings, treatment and outcome.

RESULTS

The ages of our patients ranged from 7 to 38 years with a mean of 19 years. Thirteen patients were children below the age of 16. The most frequent mechanism of injury was a fall (n=11). Associated lesions were identified in 7 patients. Delay between injury and diagnosis was above 12h in 16 patients. Fifteen cases were admitted with obvious signs of peritonitis. Erect chest X-ray identified a pneumoperitoneum in 11 of the 17 patients for whom it was requested. Most perforations were located in the ileum. A total of 7 complications occurred in 5 patients. These included 4 cases of post-operative peritonitis. Two patients with at least one associated lesion died.

CONCLUSION

ISBI is seldom suspected. This causes delay in diagnosis and most cases present with a diffuse peritonitis. Early diagnosis and management in low income environment is likely to be improved by a greater awareness of clinicians about this injury, serial clinical assessment and repeated erect chest X-ray, rather than sophisticated tools such as CT scan or laparoscopy.

Perforating small bowel injuries in children: influence of time to operation on outcome

The purpose of this study was to determine whether delay in the diagnosis of small bowel injury (SBI) affected the outcome of paediatric patients who required surgical interventions in the treatment of small bowel injuries. A retrospective chart review was performed on children with traumatic SBI requiring surgical management between January 2000 and December 2002. Diagnostic interval was defined as the time from presentation to operative treatment and delay was an interval of greater than 8 h. Thirteen patients were admitted for operative treatment of SBI. Nine cases were the result of motor vehicle trauma. The mean diagnostic interval for all patients was 9.1 h+/-7.4 h (range 0.6 h-22.5 h). Six patients had a diagnostic delay with a mean diagnostic interval of 15.5 h+/-5.5 h. There was no statistically significant difference found between the prompt and delayed diagnosis groups in terms of complications or length of hospital stay. Our finding of no difference between the prompt and delayed diagnosis groups and a diagnostic delay no longer than 22.5 h may suggest that our local methods of diagnosis and treatment assist in the prevention of unnecessary complications and death.