Abstract
We examined retrospectively 28 consecutive patients with bowel and mesenteric injuries in a 54-month period. Of the 19 blunt trauma patients, 13 (68%) were injured in a trafficaccident. A CT scan was obtained in 18 patients prior to surgery and extraluminal air was seen in only 6 cases (33%). Of three hemodynamically stable patients with neither extraluminal air nor extravasation from the mesenteric artery as seen on CT, two underwent diagnostic laparoscopy, and one had a repeat CT scan after 20 hours, and they were all diagnosed correctly. Of the 9 penetrating injury cases, 8 cases underwent a CT scan. Two cases with small abdominal wall damage and hemodynamically stability also underwent diagnostic laparoscopy. In hemodynamic unstable patients we should perform laparotomy as soon as possible, but if the patient is hemodynamic stable, we should perform diagnostic laparoscopy (or diagnostic peritoneal lavage) and CT scan, to reduce the nontherapeutic laparotomy. Transcatheter arterial embolization is effective in controlling mesenteric artery-related bleeding, but was not performed in the present study because bowel injuries could not be ruled out based on only CT scan data.
