Intestinal Trauma (Penetrating)


Background
  1. Intestinal injury from penetrating mechanisms
  2. A common injury
  3. Organs injured
  4. Peritonitis common due to perforations
  5. Injuries more common in:
  6. Generally good prognosis
  7. Mortality 40% if injury is missed
  8. Mortality 2-11% with early intervention

Pathophysiology

  1. Usually injury mechanisms
  2. Injury is mostly secondary to
  3. Anatomical considerations
  4. Injury Grades

Diagnostics

  1. History
  2. Physical exam
  3. Diagnostic testing:
  4. Diagnostic imaging
      • Positive if:
        • >10 cc gross blood, enteric contents
        • Bloody lavage effluent
        • >100,000 RBC/mm3 or >500 WBC/mm3
        • Amylase > 175 IU/dl
        • DPL fluid exits through CT or Foley catheters
        • Bacteria, vegetable fibers or food present

Differential Diagnosis

  1. Hepatic injury
  2. Diaphragmatic injury
  3. Vascular injury
  4. Splenic injury
  5. Pancreatic injury
  6. Kidney injury

Treatment

  1. ATLS as usual
  2. DO NOT remove impaling objects
  3. FAST scan / DPL
  4. NG tube / foley PRN
  5. Rapid surgical evaluation and intervention
  6. FREQUENTLY RE-ASSESS THE PATIENT
  7. Prophylactic antibiotics
  8. Tetanus prophylaxis
  9. Complications

Disposition

  1. Admit all patients
  2. Surgical consultation / treatment