Trauma to the intestine or intestinal injury is associated with abdominal trauma and injury. When there is a blunt or penetrating injury to the abdominal organs, it can lead to injury to the intestine. Abdominal injury poses a risk of severe blood loss and infection. Diagnosis of blunt trauma is often difficult and even missed out sometimes and is found predominantly in rural areas. Penetrating injuries are evident and found in urban areas.
The common sites of bowel injury are jejunum, ileum, colon which includes cecum, transverse colon and sigmoid colon. Bowel injury including mesenteric injury mechanisms can be crush and compression types or shearing and burst types. There can be active bleeding from the laceration and mesenteric hematoma. The small intestine forms a large part of the abdomen and can be intensely damaged in a penetrating injury. Bowel injury carries risk factors of infection, bowel obstruction, abscess and formation of fistula and more often requires surgery.
Causes Of Intestinal Injury
- Blunt trauma
- Causes are predominantly identified as motor vehicle collisions in case of blunt traumas. Seat belt injuries are common amongst children. Sports related injuries can also affect abdominal organs including the intestine. Bicycle mishaps and falls are also a cause of abdominal injuries in children.
- Penetrating injuries
- The cause of penetrating injuries is either high energy stab wounds or gunshot wounds. They penetrate the peritoneum and result in damaging the structures located in the abdomen.
- Other causes
- Excessive intake of aspirin and nonsteroidal anti-inflammatory drugs and steroids can cause gastrointestinal perforation which can otherwise be termed as an injury to the intestine.
Intestinal Injury Symptoms
- Abdominal pain
- Tenderness in the abdomen
- Distension or rigidity to touch
- Pneumoperitoneum: which is air or gas in the abdominal cavity
- Evisceration: protrusion of internal organs out of a wound
- Diminished or absent bowel sounds: auscultation of bowel sounds in the thorax mostly on diaphragmatic injury
- Blood in the urine
- Lap belt marks indicate small intestine rupture
- Steering wheel type contusions
Diagnosis Of Intestinal Injury
CT scan is conducted to detect hollow viscous injuries. CT scanning helps to avoid unnecessary laparotomies.
X-ray helps in determining the path of the penetration and if there is any foreign object left behind in the wound.
Peritoneal lavage is a procedure where a catheter is placed in the peritoneal cavity and any fluid present is aspirated and the area examined for blood and other material.
Diagnostic laparotomy and diagnostic laparoscopy are performed if other methods are not conclusive.
Ultrasound helps to detect the presence of fluid or spill of any gastrointestinal contents in the abdominal cavity.
Intestinal Injury Treatment
Trauma to the intestine will require surgical treatment at the earliest