Bowel injuries following blunt abdominal trauma: diagnosis and management in rural urban

Purpose: To report our experience of treatment for bowel injuries following blunt abdominal trauma in a rural area. Patients and methods: This retrospective study involved nine cases of bowel injury after blunt abdominal trauma, operated in the emergency department at the Regional Hospital of Thies from January 2009 to July 2011. We analyzed the circumstances of trauma, clinical aspects, investigations, the treatment and the postoperative course. Results: There were 8 men and 1 woman with a mean age of 27 years (14 years - 65 years). The traffic accidents were the cause in 5 cases followed by sports accidents (2 cases) and a fall from a height (2 cases). Signs of peritonitis and hemoperitoneum were found respectively in 5 and 2 cases. The clinical picture consisted of a localized defense in 2 cases. Plain abdominal X-ray showed a pneumoperitoneum in 4 cases. Ultrasound found a single intraperitoneal effusion in 2 cases and was normal in 1 case. CT-scan had diagnosed a jejunal rupture in a patient and had found a pneumoperitoneum that was missed at the plain abdominal X-ray in another patient. Four patients had undergone laparotomy less than 24 hours after injury and five after 48 hours. Perforation was found in the small intestine in 8 cases, in the sigmoid in 1 case. Treatment consisted in intestinal suture (5 cases) and resection-anastomosis (2 cases). Ileostomy was performed in a patient with septic shock. Sigmoid perforation was treated by sigmoidectomy followed by colostomy. Two deaths were noted due to severe sepsis. Conclusion: Intestinal lesions secondary to blunt abdominal trauma are difficult to diagnose. They require an early surgical treatment because it determines the prognosis.