Trauma: Small Bowel Trauma

Small Bowel (Jejunum/Ileum) Trauma

Duodenum Trauma

AAST Small Bowel Injury Scale

Destructive Bowel Injury

  • Destructive Bowel Injury Definition:
    • > 50% Circumference
    • Devascularized
    • *Grade III-V

Treatment

  • Intramural Hematoma
    • Small & Nonexpanding: Conservative
    • Large or Expanding: Hematoma Evacuation vs Resection
  • Non-Destructive: Primary Repair (Transverse Closure to Avoid Stricture)
    • Two Perforations Closely Opposed: Convert to a Single Defect
    • Multiple in a Short Segment: Resection
  • Destructive: Resection & Anastomosis, Close Mesenteric Defect

Ileum Perforation 1

Mesenteric Injury Treatment

  • Mesenteric Hematoma
    • Small & Nonexpanding: Conservative
    • Large or Expanding: Hematoma Evacuation
  • Mesenteric Tear
    • Close All Defects
    • Resect Ischemic Bowel
  • “Bucket Handle” Injury
    • Definition: Mesenteric Separation from the Bowel Causing Devascularization
    • Most Common After Motor Vehicle Crash (MVC) – Requires Significant Force
    • Most Common Site: Terminal Ileum
      • Tend to Occur Near Areas of Fixation (Cecum/Ligament of Treitz)
    • Treatment: Resection of Devitalized Bowel

Mesenteric Hematoma 2

Mesenteric Tear 3

Bucket Handle Injuries 4

References

  1. Lucke-Wold BP, Cook P, Shorter N, Bonasso P. Abdominal trauma leading to diagnosis of Crohn’s disease. Int J Surg Case Rep. 2016;26:154-5. (License: CC BY-NC-ND-4.0)
  2. Ashrafian H, Manfield JH, Mitra A, Boyle DJ, Mathur P. Spontaneous mesenteric hematoma complicating an exacerbation of Crohn’s disease: report of a case. BMC Surg. 2014 Jun 3;14:35. (License: CC BY-2.0)
  3. Go SJ, Sul YH, Ye JB, Kim JS. Appendiceal transection associated with seat belt restraint. Ann Surg Treat Res. 2016 Aug;91(2):93-5. (License: CC BY-NC-4.0)
  4. O’Dowd V, Kiernan C, Lowery A, Khan W, Barry K. Seatbelt injury causing small bowel devascularisation: case series and review of the literature. Emerg Med Int. 2011;2011:675341. (License: CC BY-3.0)