Surgical intervention for blunt bowel and mesenteric injury: indications and time intervals

• Published in: European journal of trauma and emergency surgery (Munich : 2007) Vol. 47; no. 6; pp. 1739 - 1744
• Main Authors: Okishio, Yuko, Ueda, Kentaro, Nasu, Toru, Kawashima, Shuji, Kunitatsu, Kosei, Kato, Seiya
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer Berlin Heidelberg 01.12.2021; Springer Nature B.V
• Subjects: Colon; Critical Care Medicine; Emergency medical care; Emergency Medicine; Gastrointestinal surgery; Intensive; Intervention; Laparotomy; Large intestine; Medicine; Medicine & Public Health; Mesentery; Mortality; Original Article; Sports Medicine; Surgery; Surgical Orthopedics; Trauma; Traumatic Surgery; Blunt trauma; Operative management; Time to surgery; Bowel and mesenteric injury
• ISSN: 1863-9933; 1863-9941
• DOI: 10.1007/s00068-019-01192-4

Purpose Decision making in management of blunt bowel and mesenteric injury (BBMI) is difficult. This study aimed to identify indicators for laparotomy and appropriate time intervals to surgery. Methods We retrospectively reviewed our hospital’s trauma registry to identify patients with a diagnosis of BBMI from February 2011 to July 2017. Patients requiring therapeutic surgical treatment (OM group) were compared with those who did not (NOM group). Preoperative risk factors for surgery (with p  < 0.1 by univariate analysis) were integrated in a multivariate logistic regression model. In the OM group, we identified relevant factors for time intervals to surgical interventions. Results Among 2808 trauma patients admitted to our hospital, 83 (3.0%) had bowel and mesenteric injury; 6 patients with penetrating trauma, 2 lethal, untreated cases, and 2 patients who underwent exploratory laparotomy were excluded. Finally, 73 patients (47 males), with a mean Injury Severity Score (ISS) of 23, were included. Results from univariate analysis identified three relevant factors between the OM and NOM groups: ISS score ( p  = 0.036), hemodynamic instability ( p  = 0.041), and free air ( p  = 0.0018). Multivariate analysis revealed one relevant factor, free air ( p  = 0.0002). Short intervals between hospital admission and intervention were associated with 7-day mortality ( p  = 0.029), hemodynamic instability ( p  = 0.0009), focused assessment with sonography for trauma positive ( p  < 0.0001), and mesenteric extravasation ( p  = 0.012). Conclusions Early surgical intervention is essential in cases of hemodynamically unstable BBMI and bowel perforation with free air; nevertheless, it is associated with high mortality. We suggest that prompt transport along with early intervention could significantly lessen mortality.