Dr Deepak Varma Gastro Surgeon Cochin

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Injury or trauma to the intestines

Gastrointestinal injury can be a blunt or penetrating trauma involving the colon, small bowel or rectum. The injury mechanism decides on the severity of the trauma. With blunt trauma, minor bruises to complete devascularization can be noticed. With penetrating traumas perforations along with associated solid organ injury can be noticed. Gastrointestinal traumas are rare and are usually caused due to traffic accidents. Some of the principal mechanisms are rapid acceleration and deceleration and compression of the abdomen. Colon injuries can occur due to abdominal trauma. Deceleration mechanisms present a high risk of perforation of the sigmoid colon. Mesenteric rupture and avulsion can occur to any part of the colon excluding the rectum. CT scan findings will reveal intraperitoneal fluid indicative of intestinal injury. Free intraperitoneal air is an indication of intestinal perforation. Free retroperitoneal air implies injury to retroperitoneal organs, duodenum and colon.

Hollow viscus rupture allows the contents of the intestine to enter the peritoneal cavity. This causes peritonitis.Signs and symptoms of intestinal trauma will indicate tachycardia, hypotension and diaphoresis.Diagnosis includes CT evaluation and ultrasonography. Urinalysis is done to detect hematuria in case a urinary bladder injury is suspected. CBC will establish baseline HCT. A DPL or peritoneal dialysis catheter is placed into the peritoneal cavity. It will also examine any free peritoneal fluid. Observations of the patient usually begin in the ICU. As a mode of treatment, laparotomy for control of the haemorrhage and organ repair is conducted. IV or intravenous fluid resuscitation is administered. An immediate exploratory laparotomy is done for haemodynamically unstable patients and those who have features of peritonitis.

Surgery aims at stopping the bleeding if mesenteric tears are present and to repair the perforation or holes in the intestine, if present. Occasionally, removal of part of the intestine may be required. Usually, after removal of the part of the injured intestine, the ends are joined back in the same operation. However, in a very unstable patient, both the ends of the intestines are brought out of the abdominal wall as a stoma, which can be later closed, when the patient becomes stable. This is often done as a damage control measure.

We endeavours to conduct crucial early diagnosis to establish a mode of treatment. The most common injury is perforation of the anti-mesenteric border of the small intestine.

Authored by Dr. Deepak Varma, MBBS, MS (General Surgery)

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