BACKGROUND: The purposes of this study were to evaluate the diagnosis and management of small bowel injury (SBI) and to determine significant factors affecting morbidity and mortality. METHODS: A retrospective chart review was performed including 410 patients with SBI operated between January 1994 and December 2004. Data included mechanism of injury, methods of diagnosis, time to operation, organ injury scaling, trauma scores, type of repair (enterorrhaphy vs. resection and anastomosis), morbidity (specifically fistula) and mortality. Comparisons between groups were analyzed using the Fisher and Yates tests. RESULTS: The mechanism of injury was penetrating in 321 patients (78.3%) and blunt in 89 (21.7%). There were more patients with at least 6 hours of delay to operation in the blunt trauma group than in the penetrating one (p<0.05). Enterorrhaphy was performed in 52.2% of the patients and resection with anastomosis in 46.8%, both with the same incidence of fistula (approximately 4.7%). Morbidity rate was 35.1% and fistula was more frequent in patients with therapeutic laparotomy with more than 12 hours after injury compared with laparotomy performed less than 12 hours (8.3% vs. 4.3%; not statistically significant), and it was not a determinant factor of higher mortality. The mortality rate was 13.7%, and was related to higher injury severity scores. CONCLUSION: SBI is frequent after trauma and it was most common in penetrating injuries. Blunt SBI diagnosis may be difficult, therefore causing delay in operative treatment. Occurrence of fistula was not related to the different evaluated factors: mechanism of injury, time to treatment, surgical repair, associated intra-abdominal lesions, and/or injury severity score. Mortality was related to associated injuries.
Abdominal injuries; Intestine, small; Jejunum; Ileum; Intestinal fistula
