Small bowel perforation following blunt abdominal trauma.

Small bowel perforation is a relative infrequent complication of blunt abdominal trauma. We reviewed the literature regarding this clinical entity and describe our experience in 22 patients. There were 17 male and 5 female patients; mean age was 34 years. Cause of the trauma was road traffic accident (18 cases) or fall (4 patients). Clinical investigation, peritoneal lavage, CT scanning, upper GI tract opacification and subsequent laparotomy revealed a lesion of the duodenum in 3 cases, of the jejunum in 15 cases and of the ileum in 4 cases. Therapy consisted in primary closure of the bowel (17 cases); tube drainage in 4 cases and anus praeter in 1 case. One patient died because of ARDS and inflammatory syndrome; all the other patients had an uneventful postoperative course. It is concluded that peritoneal lavage remains the most appropriate diagnostic approach. In the absence of peritonitis primary closure can be safely done; otherwise tube drainage or anus praeter construction should be performed.