Occult bowel injury after blunt abdominal trauma

Tyler J Loftus; Megan L Morrow; Lawrence Lottenberg; Martin D Rosenthal; Chasen A Croft; R Stephen Smith; Frederick A Moore; Scott C Brakenridge; Robert Borrego; Philip A Efron; Alicia M Mohr

doi:10.1016/j.amjsurg.2018.11.018

Occult bowel injury after blunt abdominal trauma

Am J Surg. 2019 Aug;218(2):266-270. doi: 10.1016/j.amjsurg.2018.11.018. Epub 2018 Nov 28.

Authors

Affiliations

¹ University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA. Electronic address: Tyler.Loftus@surgery.ufl.edu.
² Florida Atlantic University, Department of Surgery, Boca Raton, FL, USA; St. Mary's Medical Center, Department of Surgery, West Palm Beach, FL, USA. Electronic address: mmorrow7@health.fau.edu.
³ Florida Atlantic University, Department of Surgery, Boca Raton, FL, USA; St. Mary's Medical Center, Department of Surgery, West Palm Beach, FL, USA. Electronic address: lawrence.lottenberg@gmail.com.
⁴ University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA. Electronic address: Martin.Rosenthal@surgery.ufl.edu.
⁵ University of Florida Health, Department of Surgery, Gainesville, FL, USA. Electronic address: Chasen.Croft@surgery.ufl.edu.
⁶ University of Florida Health, Department of Surgery, Gainesville, FL, USA. Electronic address: Steve.Smith@surgery.ufl.edu.
⁷ University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA. Electronic address: Frederick.Moore@surgery.ufl.edu.
⁸ University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA. Electronic address: Scott.Brakenridge@surgery.ufl.edu.
⁹ Florida Atlantic University, Department of Surgery, Boca Raton, FL, USA; St. Mary's Medical Center, Department of Surgery, West Palm Beach, FL, USA. Electronic address: borrego1991@att.net.
¹⁰ University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA. Electronic address: Philip.Efron@surgery.ufl.edu.
¹¹ University of Florida Health, Department of Surgery, Gainesville, FL, USA; University of Florida Health, Sepsis and Critical Illness Research Center, Gainesville, FL, USA. Electronic address: alicia.mohr@surgery.ufl.edu.

Abstract

Background: Following blunt abdominal trauma, bowel injuries are often missed on admission computed tomography (CT) scan.

Methods: Multicenter retrospective analysis of 176 adults with moderate-critical blunt abdominal trauma and admission CT scan who underwent operative exploration. Patients with a bowel injury missed on CT (n = 36, 20%) were compared to all other patients (n = 140, 80%).

Results: The missed injury group had greater incidence free fluid without solid organ injury on CT scan (44% vs. 25%, p = 0.038) and visceral adhesions (28% vs. 6%, p = 0.001). Independent predictors of missed bowel injury included prior abdominal inflammation (OR 3.74, 95% CI 1.37-10.18), CT evidence of free fluid in the absence of solid organ injury (OR 2.31, 95% CI 1.03-5.19) and intraoperative identification of visceral adhesions (OR 4.46, 95% CI 1.52-13.13).

Conclusions: Patients with visceral adhesive disease and indirect evidence of bowel injury on CT scan were more likely to have occult bowel injury.

Keywords: Adhesions; Bowel injury; Computed tomography; Surgery; Trauma.

Publication types

Multicenter Study
Research Support, N.I.H., Extramural

MeSH terms

Abdominal Injuries / complications*
Adult
Female
Humans
Intestines / diagnostic imaging*
Intestines / injuries*
Male
Middle Aged
Missed Diagnosis*
Retrospective Studies
Tomography, X-Ray Computed*
Wounds, Nonpenetrating / complications*

Abstract

Publication types

MeSH terms

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