Gastrointestinal trauma.

The incidence of gastrointestinal trauma is low in comparison with solid organ injury to the abdomen. The most commonly injured organs are the small bowel and colon. Knowledge of the mechanism of injury alerts the nurse to areas of potential injury and guides the clinical examination. Because of the delayed presentation of these injuries, the nurse must have a high degree of suspicion for the patient who presents with the following clinical findings: bruising of the abdomen, abdominal tenderness or guarding, leukocytosis and elevated amylase and lipase, absent or decreased bowel sounds, and abdominal distention. Morbidity and mortality are directly related to the failure to treat the injuries early and the number of associated injuries. Monitoring of the hemodynamic, respiratory, and metabolic status, along with fluid and electrolyte balance, are key in the management of patients. Surveillance for signs of infection is mandatory for preventing sepsis in these types of injuries. Maintenance of skin integrity is a major concern and requires vigilant nursing care and, in some instances, innovative ways to manage the drainage from wounds and drains. Continuous monitoring and surveillance of the patient with trauma to the gastrointestinal tract will alert the nurse to the injury and prevent complications. These include hemorrhage, abscess, fistula, peritonitis, pancreatitis, esophageal stricture, and wound problems.