Thirteen Cases of Small Intestinal Perforation caused by Blunt Trauma

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  • 緊急手術を施行した外傷性全層性小腸損傷13例の検討

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Abstract

We retrospectively reviewed 13 patients who had undergone surgery at our hospital for small intestinal perforation caused by blunt abdominal trauma between July 1997 and November 2005. One woman and 12 men were examined, ranging in age from 6 to 72 years (average, 48.3). In 11 of the 13 patients (84.6%), the perforation was caused by blunt trauma sustained in a traffic accident. Some patients had slight abdominal symptoms immediately after the injury, however, all the patients eventually developed signs of peritoneal irritation Computed tomographic (CT) scans obtained immediately after the injury revealed intra-abdominal free air in 7 of the 13 patients (53.8%). In all the three patients in whom the first CT conducted 10 to 24 hours after the injury did not reveal free air in the abdomen, a second CT conducted subsequently revealed free air. Therefore, CT may be considered as one of the most accurate means of diagnosing a small intestinal perforation. In some patients, however, the diagnosis was delayed because physical examination, blood analysis and imaging failed to reveal any crucial findings. In such cases, invasive diagnosis, such as a diagnostic peritoneal lavage and diagnostic laparoscopy, may be recommended for early diagnosis.

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