경희대학교
의과대학 응급의학교실
이승철·박성준·김명천·고영관
Small
Bowel Perforation After Blunt Abdominal Trauma:
What
are the Prognostic Factors ? A
Retrospective Study from 1985 to 2000
Seung
Chul Lee, M.D., Sung Jun Park. M.D., Myung
Chun Kim, M.D., and Young Gwan Ko. M.D.
Department
of Emergency Medicine, College of Medicine, Kyung Hee University.
Background
: Blunt small bowel injury (SBI) is infrequent. Although it has been reported to
be the third most common injury in blunt abdominal trauma, it occurs in less than
1% of blunt trauma victims. The purposes of this study were to evaluate the relationship
between prognostic factors and outcomes of small bowel injury after blunt abdominal
trauma. We also attempted to design an algorithm of evaluation to facilitate rhe
detection of hollow organ injury, while at the same time reducing the risk of nontherapeutic
laparotomy.
Method
: A retrospective chart review of all blunt trauma patients with small bowel injury(SBI)
admitted to a level 3 trauma center between January 1985 and December 1996 was undertaken.
Each record was reviewed for laboratory finding and diagnostic method.
Result
: A total of 71 patients met the inclusion criteria: 85.9% were male, the mean age
was 40.9 years, the mean GCS score was 13.9, the mean RTS score was 21.5 and the
mean Injury Severity Scorc was 16.5. Twenty-six patients had multiple injuries,
and forty-five patients isolated small bowel injuries. There were 6 deaths (8.4%),
and a total of 22 patients suffered complications.
Conlusion
: In the case of initial management for blunt abdominal injured patients who also
have multiple trauma, the time interval between injury and surgery, the trauma score
(GCS, RTS) and ISS were important prognostic factors. If the patients' initial GCS
score levels were below 10, it was a good idea to useas invasive diagnostic modality
(DPL) actively to reduce preventable mortality and morbidity in the emergency department.
Key
Words : Small bowel injury, Blunt abdominal trauma, Prognostic factor |
