Gastrointestinal disruption: the hazard of nonoperative management in adults with blunt abdominal injury.

The danger inherent to nonoperative management of patients with blunt abdominal injury is that gastrointestinal disruptions will escape timely diagnosis and repair. However, children with blunt abdominal injury have been successfully treated nonoperatively for more than a decade. It has been recently proposed, based upon small series, that adults can be managed nonoperatively in a manner similar to that for children. To assess the likely safety for nonoperative management of adults with blunt abdominal injury, we determined the frequency of blunt gastrointestinal disruption in adults, and reviewed the sensitivity of the diagnosis of gastrointestinal disruption by computed tomography. The salient statistically significant findings, based upon an analysis of 6,301 adults and 1,275 children admitted following blunt trauma, were that blunt abdominal injury, blunt gastrointestinal injury, and blunt gastrointestinal disruption are much more frequent in adults. Based upon these findings and the low sensitivity reported for the diagnosis of gastrointestinal disruption by computed tomography, we conclude that the nonoperative management of adults with blunt abdominal injury is as a matter of routine not justified.