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The Effect of a Delay in Diagnosis for Bowel Injuries after Blunt Abdominal Trauma

Author: WuZhiWei
Tutor: ChenLi
School: Zhejiang University
Course: Department of General Surgery
Keywords: Blunt abdominal trauma bowel injuries Mesenteric injuries Delay in Diagnosis Prognosis
CLC: R656.1
Type: Master's thesis
Year: 2011
Downloads: 4
Quote: 0
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Abstract


Objective: Abdominal internal organs injuries after blunt abdominal trauma are infrequent, difficult to diagnose, rapidly development. Solid visceral including the liver, spleen and kidney damage, can diagnose by CT scan and B ultrasonic examination. But bowel and mesenteric injury after BAT are clinically relatively rare, also relatively difficult to diagnosis. I investigated whether a delay in diagnosis of more than 6 hours had a significant impact on morbidity, mortality, and length of stay in hospital.Method:A retrospective chart review spanning the period from March 2000 to March 2011 in the Second Affiliated Hospital of Zhejiang University, identified 76 patients with laparotomy-confirmed Bowel and mesenteric injuries. We do the Glasgow Coma Scale Score (GCS) and Injury Severity Score (ISS)for each patient. In order to control the rest of the serious injury to the prognosis of patients with concurrent impact, we rejected the patients whose GCS is below five points(5 points below are heavy or extremely heavy), or whose ISS score is 25 points above (25 points above for serious injury),All the patients were desperate into two groups by the length of time between the arrival to the emergency room and being in the operating room, patients with a short diagnosis less than 6 hours were called early operating group, while patients with a delay in diagnosis of greater than 6 hours were called delayed diagnosis group. Result:I found that the delayed diagnosis group experienced 50 percent longer hospital stays (P <0.05),39 percent longer intensive care unit stays (P<0.01), and 58 percent longer duration of mechanical ventilation (P<0.05). Patients in the delayed group also had significantly higher odds of developing acute respiratory distress syndrome, as well as trends toward higher odds of infection, pneumonia, multiple organ dysfunction syndrome, renal failure, and ileus. No significant difference in mortality was observed among all 76 patients (P>0.05).Conclusion:The laparotomy for the patients with Bowel and Mesenteric injuries after blunt abdominal trauma should be as soon as possible. My review indicates that a delay in the diagnosis of bowel and mesenteric injuries results in significantly increased hospital and intensive care unit lengths of stay.

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CLC: > Medicine, health > Surgery > Of surgery > Abdominal surgery > Acute abdomen
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