Presentation of blunt small intestinal and mesenteric injuries

During the 10 year period from 1988 to 1997, 64 patients with blunt small b owel and mesenteric injuries were treated at two trauma centres. The majori ty (52 cases) were victims of motor vehicle accidents, and 54% of them wore seat belts at the time of the accident. There were 22 small bowel injuries (17 full-thickness and 5 seromuscular) and 42 mesenteric injuries (7 with and 35 without a devascularised bowel segment). Shock on admission was pres ent in 34% of the patients and generalised abdominal tenderness in 75%. Dia gnostic peritoneal lavage was positive for blood in 25 out of 36 cases in w hich it was performed (69%), and positive for bowel content in 4/6 patients (67%) with full-thickness bowel perforations or transactions. Emergency ro om ultrasound was positive for blood in 13/25 cases (52%), and CT scan in 7 /17 (41%). It is concluded that blunt small bowel and mesenteric injuries i ncluding patients with perforated or ischaemic bowel are difficult to diagn ose using currently available diagnostic tools, and require a low threshold for exploration based on clinical suspicion in order to reduce the complic ations following delayed treatment of these injuries.