Impact of early recognition on outcome in nonpenetrating wounds of the small bowel.

During a recent ten-year period, 20 patients were treated for nonpenetrating, small-bowel trauma requiring resection. Despite the relative infrequency of this injury, jejunoileal trauma must be suspected in all patients sustaining blunt force to the abdomen. Physical signs suggesting major intra-abdominal wounds usually occur at admission or immediately thereafter, provided the patient is alert. Patients with altered sensorium or equivocal findings should undergo diagnostic peritoneal lavage. Laboratory investigation is not helpful in detecting small-bowel wounds. Plain roentgenography is indicated, but was diagnostic in only 20% of patients in this series. The high incidence of associated injuries accounts for the substantial morbidity (70%) in this series. Early operation improves survival.