Intestinal Trauma (Blunt)


Background
  1. Injury to intestines resulting from blunt force to abdomen
  2. Most commonly injured hollow organ
  3. Commonly seen as "seat belt" injuries
  4. Easily missed diagnosis

Pathophysiology

  1. Injury mechanism
  2. Anatomy
  3. Potential injuries
  4. Associated complications
  5. Injury Grades (AAST scale)

Diagnostics

  1. History
  2. Symptoms
  3. Physical exam
  4. Diagnostic testing
  5. Diagnostic imaging

Differential Diagnosis

  1. Hepatic trauma
  2. Splenic trauma
  3. Pancreatic trauma
  4. Kidney trauma
  5. Pelvic fracture
  6. Abdominal wall injury
  7. Spinal trauma
  8. Consider child abuse

Treatment

  1. ATLS as usual
  2. FAST scan / DPL
  3. NG tube / foley PRN
  4. Serial exams
  5. Hemodynamic stability
  6. Definitive treatment
  7. Prophylactic antibiotics
      • Unasyn 3 g IV q6h
      • Piperacillin / tazobactam 4.5 g IV q8h
      • 2nd generation cephalosporin
        • Mefoxin
        • Cefotetan
      • Triple therapy
        • Ampicillin 2 g IV q6h PLUS
        • Gentamicin 2 mg/kg load; 1.7 mg/kg q8h PLUS
        • Metronidazole 1 g IV q12h
  8. Tetanus prophylaxis

Disposition

  1. All patients are admitted