Robbs J V, Moore S W, Pillay S P
J Trauma. 1980 Apr;20(4):308-11.
Jejunal perforation is relatively common following focal blunt abdominal trauma. The mortality rate remains in the region of 30%. Significant factors affecting mortality are therapeutic delay of 24 hours or more, and multiple injuries. The commonest clinical features are abdominal pain, tenderness, and guarding, diminished or absent bowel sounds and signs of hypovolemia. Diagnostic difficulty is presented by the patient with an impaired level of consciousness and/or associated remote injuries which may distract the clinician from the abdomen. Delayed rupture may also occur, and observation should continue for at least 48 to 72 hours with a warning to return immediately if pain recurs. Straight abdominal and chest radiography are of limited diagnostic value, but nevertheless may prove helpful in 50% of cases. All patients with multiple injuries, particularly in the presence of a head injury with an impaired level of consciousness should be submitted to diagnostic abdominal paracentesis. A negative result should prompt diagnostic peritoneal lavage. Early diagnosis and aggressive therapy are essential if the mortality is to be reduced. To this end careful, frequent abdominal assessment should be practiced, with immediate laparotomy if clinical parameters deteriorate, or do not improve over a 12 to 18-hour period.
空肠穿孔在腹部钝性外伤后相对常见。死亡率仍在30%左右。影响死亡率的重要因素是治疗延迟24小时或更长时间以及多发伤。最常见的临床特征是腹痛、压痛、肌紧张、肠鸣音减弱或消失以及血容量不足的体征。意识水平受损和/或伴有远处损伤的患者会给诊断带来困难，这些情况可能会使临床医生的注意力从腹部转移开。也可能发生延迟性破裂，应持续观察至少48至72小时，并告知患者如果疼痛复发应立即返回。腹部和胸部的平片诊断价值有限，但在50%的病例中可能会有帮助。所有多发伤患者，尤其是存在意识水平受损的头部损伤患者，都应进行诊断性腹腔穿刺术。阴性结果应促使进行诊断性腹腔灌洗。如果要降低死亡率，早期诊断和积极治疗至关重要。为此，应仔细、频繁地进行腹部评估，如果临床指标恶化或在12至18小时内没有改善，应立即进行剖腹手术。
