INTESTINOMESENTERIC INJURY IN BLUNT ABDOMINAL-TRAUMA

A retrospective series of 24 intestinomesenteric lesions after blunt abdominal trauma were investigated to determine the distribution of the lesions as a function of the type of accident and to establish diagnostic and therapeutic patterns based on observed post-operative results. The chi squared test was used for statistical analysis. There were 20 men and 4 women, mean age 39 +/- 15 years (range 17-74). Trauma was caused by a traffic accident in 16 cases (67 %) including 12 victims under 40 (p < 0.01) and 14 drivers (87.5 %) (12 wore a safety belt). Haemodynamic instability or generalized abdominal defense. Pneumoperitoneum was seen on only one of the 21 (5 %) admission X-rays. Abdominal echography was often ordered (16 times). The mean interval between trauma and surgical intervention was 39 hours. Injury involved the mesentery (n = 15), the small intestin (n = 14), the colon (n = 7) and the colic mesenteriolum (n = 4). Lesions of the colon were observed more often in automobile accidents (p < 0.05). Injury to other abdominal organs was also observed in 12 patients : liver (n = 6), spleen (n = 5) and pancreas (n = 5). The thorax was involved in 14 patients including 11 under 40 (p < 0.01). Nine intestinal resections/anastomoses, 9 enterroaphies (including 4 colic injuries) and 1 Hartman were performed. Two patients died (8.3 %) and follow-up was complicated in 14 (including the 2 deaths). Wearing the safety belt did not affect the greater number of intestinomesentric lesions. In subjects wearing a safety belt, there were more injuries of the thorax but less neurological involvement. Postoperative morbidity and mortality depended more on the associated lesions than the intestinomesenteric injury itself.