Bloom A I, Rivkind A, Zamir G, Gross E, Kluger Y, Reissman P, Muggia-Sullam M
Department of Radiology, Hadassah University Hospital, Kiryat Hadassah, Jerusalem, Israel.
Eur J Emerg Med. 1996 Jun;3(2):85-91. doi: 10.1097/00063110-199606000-00005.
Eighteen patients with small intestine or mesenteric injury following blunt abdominal trauma were operated over a 34-month period. Early diagnosis and surgery, less than 6 hours after admission, was achieved in 10 patients (56%), seven of whom had haemorrhagic shock and had positive diagnostic peritoneal lavage or ultrasonography on admission. Three haemodynamically stable patients had a diagnostic abdominal computed tomography. Diagnosis was delayed in eight patients (44%) resulting in a gap between admission and surgery that varied from 20 hours to 46 days. The delay was related to lack of suspicion of injuries in haemodynamically stable patients despite a seat-belt sign, or false negative abdominal computed tomography. Diagnosis was delayed in six of seven patients (86%) where the only injury on admission was an isolated intestinal or mesenteric injury. In 11 patients there were associated abdominal or other system injuries. Late diagnosis was associated with an increased morbidity and longer hospital stay, relating to intestinal and mesenteric injury. In conclusion, a seat belt sign is highly suspicious of intestinal or mesenteric injury. Computed tomography was unreliable in diagnosing blunt intestinal and mesenteric injuries, and if equivocal, should be followed by diagnostic peritoneal lavage if nonoperative management is selected. Delayed diagnosis is often related to isolation of intestinal and mesenteric injury and results in increased morbidity and hospital stay. Every attempt should be made to reach a diagnosis within six hours of admission to the trauma unit. A management algorithm is proposed.
在34个月的时间里，对18例腹部钝性创伤后出现小肠或肠系膜损伤的患者进行了手术。10例患者（56%）在入院后6小时内实现了早期诊断和手术，其中7例有失血性休克，入院时诊断性腹腔灌洗或超声检查呈阳性。3例血流动力学稳定的患者进行了诊断性腹部计算机断层扫描。8例患者（44%）诊断延迟，导致入院与手术之间的间隔时间从20小时到46天不等。延迟与血流动力学稳定的患者尽管有安全带征但对损伤缺乏怀疑，或腹部计算机断层扫描假阴性有关。在入院时唯一损伤为孤立性肠或肠系膜损伤的7例患者中，6例（86%）诊断延迟。11例患者伴有腹部或其他系统损伤。延迟诊断与发病率增加和住院时间延长有关，与肠和肠系膜损伤有关。总之，安全带征高度怀疑肠或肠系膜损伤。计算机断层扫描在诊断钝性肠和肠系膜损伤方面不可靠，如果结果不明确，若选择非手术治疗，应随后进行诊断性腹腔灌洗。延迟诊断通常与肠和肠系膜损伤的孤立有关，并导致发病率增加和住院时间延长。应尽一切努力在创伤病房入院后6小时内做出诊断。提出了一种处理算法。
