Trauma & Short Bowel Syndrome

Injury and Trauma can be contributing factors to SBS if the small bowel is damaged to where a large portion must be resected from the abdomen.

Intestinal trauma can be classified as:

-Internal bleeding

-Intestinal volvulus

-Blunt force trauma to the abdomen

SBS can be caused by removal of a large portion of the small intestine, which can result in malabsorption of nutrients.

Abdominal Trauma

Abdominal trauma refers to an injury sustained in the abdomen, which can be either blunt or penetrating, potentially causing harm to the abdominal organs. Common signs and symptoms encompass abdominal pain, tenderness, rigidity, and external abdomen bruising. This type of trauma poses a significant risk of severe blood loss and infection. Diagnostic methods may include ultrasonography, computed tomography, and peritoneal lavage, while treatment may entail surgical interventions. Additionally, injuries to the lower chest may result in splenic or liver damage.

Signs & Symptoms

Individuals involved in traffic accidents might exhibit a “seat belt sign,” characterized by bruising on the abdomen along the lap portion of the safety belt, indicating a high likelihood of abdominal organ injuries.[5] Seatbelts can also cause abrasions and hematomas, with up to 30 percent of individuals displaying these signs experiencing associated internal injuries.[3] Early signs of abdominal trauma include nausea, vomiting, fever, and blood in the urine.[5] The injury may manifest as abdominal pain, tenderness, distension, or rigidity upon touch, and bowel sounds may be diminished or absent. Abdominal guarding, a tensing of abdominal wall muscles to protect inflamed organs, may also be observed.

In cases of penetrating injuries, evisceration (protrusion of internal organs from a wound) may occur.[7]

Injuries linked to intra-abdominal trauma encompass rib fractures, vertebral fractures, pelvic fractures, and injuries to the abdominal wall.[8]

Causes

Vehicle accidents frequently cause blunt abdominal trauma.[3] While seat belts can decrease the occurrence of injuries like head and chest injuries, they pose a risk to abdominal organs such as the pancreas and intestines. This risk arises from the potential compression of these organs against the spinal column.[3] Children, with their softer abdominal regions, are particularly susceptible to abdominal injuries from seat belts, as these safety devices were not designed to properly fit them.[5]

In the case of children, bicycle accidents also commonly lead to abdominal injuries, especially when the abdomen makes contact with the handlebars.[5] Abdominal organs like the spleen and kidneys can be affected by sports injuries, with falls and sports serving as frequent mechanisms of abdominal injury in children.[4][5]

Additionally, abdominal injuries can result from child abuse, ranking as the second leading cause of child abuse-related deaths after traumatic brain injury.[6]

Gunshot wounds, being higher in energy compared to stab wounds, generally inflict more damage. In particular, gunshot wounds that penetrate the peritoneum often result in significant damage to major intra-abdominal structures, occurring in over 90 percent of cases.[9]

Diagnosis

Various diagnostic techniques are employed, including CT scanning, ultrasound, and X-ray. X-ray is useful for determining the path of a penetrating object and identifying foreign matter in wounds but may be less effective in blunt trauma. Diagnostic peritoneal lavage, a controversial method, can detect abdominal organ injuries by aspirating and examining fluid in the peritoneal cavity for blood or signs of rupture. However, it carries risks and has been largely replaced by ultrasound in Europe and North America. Ultrasound, a noninvasive and safe procedure, can detect abdominal cavity fluid like blood or gastrointestinal contents. CT scanning is preferred for stable patients, while ultrasound is recommended for those not stable enough for CT scanning. Abdominal CT scans can be conducted simultaneously with other trauma-related scans, such as head or chest CT. If conclusive results are not obtained, diagnostic laparoscopy or exploratory laparotomy may be performed.

Treatment & Outcomes

The initial approach focuses on stabilizing the patient to ensure sufficient airway, breathing, and circulation while identifying any additional injuries. Surgery may be necessary to repair damaged organs, particularly in cases of penetrating injuries with signs of peritonitis or shock. In instances of blunt abdominal trauma, laparotomy is often performed and is urgently required for significant, potentially life-threatening bleeding. Nonetheless, many intra-abdominal injuries can be successfully treated without surgery, thanks to the use of CT scanning, which helps identify injuries suitable for conservative management and rules out those requiring surgery. The need for intensive care depends on the nature of the injuries.

A prompt diagnosis of abdominal injury is crucial, as delayed treatment, especially in cases involving gastrointestinal tract perforation, is associated with high morbidity and mortality. It’s important to note that a significant number of deaths resulting from abdominal trauma are preventable, making abdominal trauma a leading cause of preventable, trauma-related fatalities.

References

  1. ^ a b c d e f g h i j k Jansen JO, Yule SR, Loudon MA (April 2008). “Investigation of blunt abdominal trauma”. BMJ 336 (7650): 938–42. doi:10.1136/bmj.39534.686192.80. PMC 2335258.PMID 18436949.
  2. ^ Wyatt, Jonathon; Illingworth, RN. Graham, CA. Clancy, MJ. Robertson, CE (2006). Oxford Handbook of Emergency Medicine. Oxford University Press. p. 346. ISBN 978-0-19-920607-0.
  3. ^ a b c d e f g h i j k l m Hemmila MR, Wahl WL (2005). “Management of the Injured Patient”. In Doherty GM. Current Surgical Diagnosis and Treatment. McGraw-Hill Medical. pp. 227–8. ISBN 0-07-142315-X. Retrieved 2008-06-21.
  4. ^ a b c d e f g h i Yeo A (2004). “Abdominal trauma”. In Chih HN, Ooi LL. Acute Surgical Management. World Scientific Publishing Company. pp. 327–33. ISBN 981-238-681-5. Retrieved 2008-06-21.
  5. ^ a b c d e f g h i j k l m n o p q r s Bixby SD, Callahan MJ, Taylor GA (January 2008). “Imaging in pediatric blunt abdominal trauma”. Semin Roentgenol 43 (1): 72–82.doi:10.1053/j.ro.2007.08.009. PMID 18053830.
  6. ^ a b c Lichtenstein R, Suggs AH (2006). “Child abuse/assault”. In Olshaker JS, Jackson MC, Smock WS. Forensic Emergency Medicine: Mechanisms and Clinical Management (Board Review Series). Hagerstown, MD: Lippincott Williams & Wilkins. pp. 157–9. ISBN 0-7817-9274-6. Retrieved 2008-06-21.
  7. ^ Chih, p.343
  8. ^ a b c Hemmila, p. 231
  9. ^ a b Chih, pp. 346–348
  10. ^ a b c d Blank-Reid C (September 2006). “A historical review of penetrating abdominal trauma”.Crit Care Nurs Clin North Am 18 (3): 387–401. doi:10.1016/j.ccell.2006.05.007.PMID 16962459.
  11. ^ a b Fabian TC, Bee TK (2004). “Liver and biliary trauma”. In Moore EJ, Feliciano DV, Mattox KL.Trauma. New York: McGraw-Hill, Medical Pub. Division. pp. 637. ISBN 0-07-137069-2. Retrieved 2008-06-21.
  12. ^ a b c d e f g h Visrutaratna P, Na-Chiangmai W (April 2008). “Computed tomography of blunt abdominal trauma in children”. Singapore Med J 49 (4): 352–8; quiz 359. PMID 18418531.
  13. ^ Amal Mattu; Deepi Goyal; Barrett, Jeffrey W.; Joshua Broder; DeAngelis, Michael; Peter Deblieux; Gus M. Garmel; Richard Harrigan; David Karras; Anita L’Italien; David Manthey (2007). Emergency medicine: avoiding the pitfalls and improving the outcomes. Malden, Mass: Blackwell Pub./BMJ Books. pp. 61. ISBN 1-4051-4166-2.
  14. ^ Demetriades D, Velmahos G, Cornell E 3rd, et al. Selective nonoperative management of gunshot wounds of the anterior abdomen. Arch Surg 1997; 132:178–183
  15. ^ Goodman CS, Hur JY, Adajar MA, Coulam CH., How well does CT predict the need for laparotomy in hemodynamically stable patients with penetrating abdominal injury? A review and meta-analysis., AJR Am J Roentgenol. 2009 Aug;193(2):432-7.