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Small Bowel Injury

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Sew it up! A Western Trauma Association multi-institutional study of enteric injury management in the postinjury open abdomen.
Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Crowell K, Nirula R, Haan J, Rowell SE, Kato CM, MacNew H, Ochsner MG, Harrison PB, Fusco C, Sauaia A, Kaups KL; WTA Study Group.
J Trauma. 2011 Feb;70(2):273-7

Rationale for inclusion: The results of this WTA multi-institutional trial recommend repair of intestinal injuries should be considered in all patients including those with post-injury open abdomens, identifying higher leak rates with fascial closure beyond 5 days.  

Citations - 53 (as of July 2017)

Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the EAST multi-institutional HVI trial.
Fakhry SM, Watts DD, Luchette FA; EAST Multi-Institutional Hollow Viscus Injury Research Group.
J Trauma. 2003 Feb;54(2):295-306.

Rationale for inclusion: This represents the results of the EAST multi-institutional trial from 95 trauma centers, concluding that current diagnostic modalities are not sensitive for the diagnosis of traumatic bowel injury, with 13% of patients with small bowel injury demonstrating normal initial CT imaging.

Citations - 161 (as of July 2017)

Blunt bowel and mesenteric injuries: the role of screening computed tomography.
Malhotra AK, Fabian TC, Katsis SB, Gavant ML, Croce MA.
J Trauma. 2000 Jun;48(6):991-8; discussion 998-1000.

Rationale for inclusion: Analysis of 8112 abdominal CT scans identified that helical scanners are increasingly more accurate in identification of blunt bowel and mesenteric injuries but remain with a significant false positive and false negative rate.

Citations - 165 (as of July 2017)

Relatively short diagnostic delays (<8 hours) produce morbidity and mortality in blunt small bowel injury: an analysis of time to operative intervention in 198 patients from a multicenter experience.
Fakhry SM, Brownstein M, Watts DD, Baker CC, Oller D.
J Trauma. 2000 Mar;48(3):408-14; discussion 414-5.

Rationale for inclusion: Using data collected from 8 trauma centers evaluating the effect of diagnostic delays in blunt small bowel injuries, this analysis stressed the importance of prompt recognition of bowel injury, given their finding that relatively brief delays (8 hours) contributed to increased morbidity and mortality.

Citations - 271 (as of July 2017)

Incidence and significance of free fluid on abdominal computed tomographic scan in blunt trauma.
Brasel KJ, Olson CJ, Stafford RE, Johnson TJ.
J Trauma. 1998 May;44(5):889-92.

Rationale for inclusion: A retrospective review of CT findings of free intraabdominal fluid after blunt trauma, this study concluded that the presence of more than trace amounts of free fluid is a strong indication for laparotomy given high rates of bowel injury.

Citations - 143 (as of July 2017)

The accuracy of computed tomography in the diagnosis of blunt small-bowel perforation.
Sherck J, Shatney C, Sensaki K, Selivanov V.
Am J Surg. 1994 Dec;168(6):670-5.

Rationale for inclusion: This study evaluated the utility of CT to identify blunt small bowel perforation and injury, siting subtle and nonspecific findings on imaging including free fluid or small bowel thickening and dilation.  In 2 of 24 patients, no abnormalities were found in CT imaging, warranting close observation or additional diagnostic tests.

Citations - 165 (as of July 2017)

The serum amylase in blunt abdominal trauma.
Olsen WR.
J Trauma. 1973 Mar;13(3):200-4.

Rationale for inclusion: This series by Olsen in 1973 described the use of hyperamylasemia as an adjunct to the assessment for blunt abdominal trauma.  

Citations - 139 (as of July 2017)

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