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

Occult bowel injury after blunt abdominal trauma.

Author information

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

PMID:
30509454
PMCID:
PMC6538466
[Available on 2020-08-01]
DOI:
10.1016/j.amjsurg.2018.11.018

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