The Impact of Prior Laparotomy and Intra-abdominal Adhesions on Bowel and Mesenteric Injury Following Blunt Abdominal Trauma
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Early recognition of bowel and mesenteric injury following blunt abdominal trauma remains difficult. We hypothesized that patients with intra-abdominal adhesions from prior laparotomy would be subjected to visceral sheering deceleration forces and increased risk for bowel and mesenteric injury following blunt abdominal trauma.
We performed a multicenter retrospective cohort analysis of 267 consecutive adult trauma patients who underwent operative exploration following moderate-critical (abdominal injury score 2–5) blunt abdominal trauma, comparing patients with prior laparotomy (n = 31) to patients with no prior laparotomy (n = 236). Multivariable regression was performed to identify predictors of bowel or mesenteric injury.
There were no significant differences between groups for injury severity scores or findings on abdominal ultrasound, diagnostic peritoneal aspirate/lavage, pelvic radiography, or preoperative CT scan. The prior laparotomy cohort had greater incidence of full thickness bowel injury (26 vs. 9%, p = 0.010) and mesenteric injury (61 vs. 31%, p = 0.001). The proportion of bowel and mesenteric injuries occurring at the ligament of Treitz or ileocecal region was greater in the no prior laparotomy group (52 vs. 25%, p = 0.003). Prior laparotomy was an independent predictor of bowel or mesenteric injury (OR 5.1, 95% CI 1.6–16.8) along with prior abdominal inflammation and free fluid without solid organ injury (model AUC: 0.81, 95% CI 0.74–0.88).
Patients with a prior laparotomy are at increased risk for bowel and mesenteric injury following blunt abdominal trauma. The distribution of bowel and mesenteric injuries among patients with no prior laparotomy favors embryologic transition points tethering free intraperitoneal structures to the retroperitoneum.
This work was supported in part by Grants R01 GM113945-01 (PAE), R01 GM105893-01A1 (AMM), and P50 GM111152–01 (FAM, SCB, PAE, AMM) awarded by the National Institute of General Medical Sciences (NIGMS). TJL was supported by a post-graduate training grant (T32 GM-008721) in burns, trauma and perioperative injury by NIGMS. Research reported in this publication was supported by the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR001427. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
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Conflict of interest
The Authors declare that they have no conflict of interest.
- 5.Udekwu PO, Gurkin B, Oller DW (1996) The use of computed tomography in blunt abdominal injuries. Am Surg 62(1):56–59Google Scholar
- 15.Schnuriger B, Lam L, Inaba K et al (2012) Negative laparotomy in trauma: are we getting better? Am Surg 78(11):1219–1223Google Scholar
- 17.Fakhry SM, Brownstein M, Watts DD et al (2000) 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. J Trauma 48(3):408–414 (discussion 414–405) CrossRefGoogle Scholar
- 22.Chandler CF, Lane JS, Waxman KS (1997) Seatbelt sign following blunt trauma is associated with increased incidence of abdominal injury. Am Surg 63(10):885–888Google Scholar
- 28.Mahmood I, Tawfek Z, Abdelrahman Y et al (2014) Significance of computed tomography finding of intra-abdominal free fluid without solid organ injury after blunt abdominal trauma: time for laparotomy on demand. World J Surg 38(6):1411–1415. https://doi.org/10.1007/s00268-013-2427-5 CrossRefGoogle Scholar
- 33.Livingston DH, Lavery RF, Passannante MR et al (1998) Admission or observation is not necessary after a negative abdominal computed tomographic scan in patients with suspected blunt abdominal trauma: results of a prospective, multi-institutional trial. J Trauma 44(2):273–280 (discussion 280–272) CrossRefGoogle Scholar
- 37.Drollette CM, Badawy SZ (1992) Pathophysiology of pelvic adhesions. Modern trends in preventing infertility. J Reprod Med 37(2):107–121 (discussion 121–102) Google Scholar