T Bège1,2, K Chaumoître3, M Léone4, J Mancini5, S V Berdah6,7, C Brunet6,7. 1. Department of General and Digestive Surgery, APHM North Hospital, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France. thierry.bege@ap-hm.fr. 2. Laboratoire de Biomécanique Appliquée UMR 24, Aix-Marseille University, Boulevard Pierre Dramard, 13015, Marseille, France. thierry.bege@ap-hm.fr. 3. Department of Radiology, APHM North Hospital, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France. 4. Department of Anesthesia and Resuscitation, APHM North Hospital, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France. 5. Department of Public Health and Medical Information, APHM Timone, Aix-Marseille University, 13006, Marseille, France. 6. Department of General and Digestive Surgery, APHM North Hospital, Aix-Marseille University, Chemin des Bourrely, 13015, Marseille, France. 7. Laboratoire de Biomécanique Appliquée UMR 24, Aix-Marseille University, Boulevard Pierre Dramard, 13015, Marseille, France.
Abstract
BACKGROUND: There is no consensually accepted approach to the management of blunt bowel and mesenteric injuries. Surgery is required urgently in the case of bowel perforation or haemodynamic instability, but several patients can be treated non-operatively. This study aimed to identify the risk factors for surgery in an initial assessment. METHODS: We retrospectively reviewed the medical charts and computed tomography (CT) scans of adult patients presenting with a blunt abdominal trauma to our centre between the years 2004 and 2011. We included only patients with a CT scan showing suspected injury to the mesentery or bowel. RESULTS: There were 43 patients (33 males and 10 females), with a mean Injury Severity Score (ISS) of 22. The most frequently suspected injuries based on a CT scan were mesenteric infiltrations in 40 (93 %) patients and bowel wall thickening in 22 (51 %) patients. Surgical therapy was required for 23 (54 %) patients. Four factors were independently associated with surgical treatment: a free-fluid peritoneal effusion without solid organ injury [adjusted odds ratio (OR) = 14.4, 95 % confidence interval (CI) [1.9-111]; p = 0.015], a beaded appearance of the mesenteric vessels (OR = 9 [1.3-63]; p = 0.027), female gender (OR = 14.2 [1.3-159]; p = 0.031) and ISS >15 (OR = 6.9 [1.1-44]; p = 0.041). Surgery was prescribed immediately for 11 (26 %) patients and with delay, after the failure of initially conservative treatment, for 12 (28 %) patients. The presence of a free-fluid peritoneal effusion without solid organ injury was also an independent risk factor for delayed surgery (OR = 9.8 [1-95]; p = 0.048). CONCLUSIONS: In blunt abdominal trauma, the association of a bowel and/or mesenteric injury with a peritoneal effusion without solid organ injury on an initial CT scan should raise the suspicion of an injury requiring surgical treatment. Additionally, this finding should lead to a clinical discussion of the benefit of explorative laparotomy to prevent delayed surgery. However, these findings need validation by larger studies.
BACKGROUND: There is no consensually accepted approach to the management of blunt bowel and mesenteric injuries. Surgery is required urgently in the case of bowel perforation or haemodynamic instability, but several patients can be treated non-operatively. This study aimed to identify the risk factors for surgery in an initial assessment. METHODS: We retrospectively reviewed the medical charts and computed tomography (CT) scans of adult patients presenting with a blunt abdominal trauma to our centre between the years 2004 and 2011. We included only patients with a CT scan showing suspected injury to the mesentery or bowel. RESULTS: There were 43 patients (33 males and 10 females), with a mean Injury Severity Score (ISS) of 22. The most frequently suspected injuries based on a CT scan were mesenteric infiltrations in 40 (93 %) patients and bowel wall thickening in 22 (51 %) patients. Surgical therapy was required for 23 (54 %) patients. Four factors were independently associated with surgical treatment: a free-fluid peritoneal effusion without solid organ injury [adjusted odds ratio (OR) = 14.4, 95 % confidence interval (CI) [1.9-111]; p = 0.015], a beaded appearance of the mesenteric vessels (OR = 9 [1.3-63]; p = 0.027), female gender (OR = 14.2 [1.3-159]; p = 0.031) and ISS >15 (OR = 6.9 [1.1-44]; p = 0.041). Surgery was prescribed immediately for 11 (26 %) patients and with delay, after the failure of initially conservative treatment, for 12 (28 %) patients. The presence of a free-fluid peritoneal effusion without solid organ injury was also an independent risk factor for delayed surgery (OR = 9.8 [1-95]; p = 0.048). CONCLUSIONS: In blunt abdominal trauma, the association of a bowel and/or mesenteric injury with a peritoneal effusion without solid organ injury on an initial CT scan should raise the suspicion of an injury requiring surgical treatment. Additionally, this finding should lead to a clinical discussion of the benefit of explorative laparotomy to prevent delayed surgery. However, these findings need validation by larger studies.
Entities:
Keywords:
Blunt trauma; Bowel and mesenteric injury; CT scan; Surgery
Authors: Chih-Yuan Fu; Francesco Bajani; Caroline Butler; Stanley Welsh; Thomas Messer; Matthew Kaminsky; Frederick Starr; Andrew Dennis; Victoria Schlanser; Justin Mis; Stathis Poulakidas; Faran Bokhari Journal: World J Surg Date: 2019-04 Impact factor: 3.352