GASTROINTESTINAL PERFORATION FOLLOWING BLUNT ABDOMINAL TRAUMA

Abstract

ABSTRACT
Objective: To highlight the pertinent management problems of bowel perforation following blunt
abdominal trauma.
Design: A prospective descriptive study.
Setting: Hospital-based cohort over a nine year period in Jos University Teaching Hospital, Jos,
Nigeria.
Subjects: A total of 23 patients with bowel perforation out of 8,970 trauma victims with a mean
age of 28.5 years.
Intervention: Exploratory laparotomy, drainage of septic peritoneal fl uid and wound saline lavage
and closure of perforations were performed in all the 23 patients with clinical features and imaging
signs suggestive of bowel perforation following blunt abdominal trauma. Femoral fractures were
splinted and tube thoracostomy were carried out in four and two patients respectively.
Main outcome measures: There is an apparent delay in presentation and diagnosis of traumatic
bowel perforation following blunt abdominal trauma. Signs of peritoneal sepsis remain the most
consistent fi ndings in our environment. The morbidity and mortality following blunt abdominal
trauma and bowel perforation are high because of established peritonitis. Delayed presentation
or large leakage of bowel content into the peritoneal cavity and the attendant ease with which
peritonitis develops in the latter are factors responsible.
Results: Delayed presentation (mean 3.05 days) was observed in seven of 23 patients. Eight patients
had concomitant injuries; two to the head, four had right femoral fracture and two blunt chest
injury. Features of peritonitis were present at initial evaluation in 19 patients. Seventeen patients
were victims of motor vehicle accident. Radiological evidence of perforation (pneumoperitoneum)
was present in only two of four patients with diffi cult diagnosis. Free peritoneal fl uid without
solid organ injury was detected in two patients with ultrasound. Diagnostic peritoneal lavage was,
therefore, not used in any of our patients. The mean time from admission to laparotomy was six
hours. Sites of perforations were: stomach (2), jejunum (9), ileum (8), jejunum/ileum (2) and colon
(2). Sepsis originating from the perforated bowel was responsible for mortality in our patients
who died in the perioperative period with concomitant injury playing signifi cant role in three of
11 patients with such injuries.
Conclusion: Peritonitis following a bowel perforation after blunt abdominal trauma is often present
at the time of presentation and diagnosis is usually made. In the few doubtful cases, often in
patients presenting soon after trauma, X-ray and trans-abdominal ultrasonography will assist in
making a diagnosis. Delayed presentation still accounts for a high mortality in bowel perforation
following blunt abdominal trauma.