Diagnosis of isolated small bowel injury following blunt abdominal trauma.

A review of the case histories of 29 patients with isolated rupture of the small bowel was undertaken to determine which diagnostic tests were most sensitive in the early diagnosis of this notoriously occult injury. Results indicate that peritoneal lavage was the most useful test for this purpose, clearly more sensitive than standard clinical or radiographic signs. All patients in this series had indications for peritoneal lavage, and 85% of the patients who underwent peritoneal lavage in the emergency department had positive results and prompt operation. Reliance on the development of clinical peritonitis or the detection of pneumoperitoneum leads to long delays before operation.