Blunt Isolated Small Bowel Perforation Intervention: Does a Delay in Management Matter?

Sung Yong Hong; Se Hun Kim; Ki Hoon Kim

doi:10.1155/2020/7478485

Blunt Isolated Small Bowel Perforation Intervention: Does a Delay in Management Matter?

Emerg Med Int. 2020 Jun 4:2020:7478485. doi: 10.1155/2020/7478485. eCollection 2020.

Authors

Sung Yong Hong¹, Se Hun Kim², Ki Hoon Kim³

Affiliations

¹ Department of Critical Care Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
² Department of Anesthesiology, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.
³ Department of Surgery, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea.

Abstract

Purpose: Blunt small bowel injury is rare, and its timely diagnosis may be difficult. The effects of a delayed intervention on prognosis are unclear. We aimed to determine whether the time to surgical intervention affects outcomes in patients with blunt small bowel perforation.

Methods: The study was performed between March 2010 and December 2018 in adults (age >18 years) who initially underwent computed tomography and small bowel surgery only and survived more than one day postoperatively. They were categorized into three groups based on injury-to-surgery time intervals: ≤8, 8-24, and >24 h; similarly, they were also categorized into two groups of ≤24 and >24 h.

Results: Bowel resection, length of stay (LOS), intensive care unit (ICU) LOS, morbidity, and mortality were analyzed as outcomes in 52 patients. The number of patients in the three groups (≤8, 8-24, and >24 h) based on the time-to-surgery was 33, 13, and 6, respectively. On comparing the three groups, there were no significant differences in LOS (24 [18-35], 21 [10-40], and 28 [20-98] days, respectively; p=0.321), ICU LOS (2 [1-12], 4 [2-26], and 11 [7-14] days; respectively, p=0.153), mortality (3% (n = 1), 15% (n = 2), and 0%, respectively; p=0.291), and morbidity (46% (n = 15), 39% (n = 5), and 50% (n = 3), respectively; p=0.871). However, there was a significant difference between the groups in bowel resection (67% (n = 22), 31% (n = 4), and 83% (n = 5), respectively; p=0.037). Additionally, there was no significant difference in outcomes between the two groups (≤24 and >24 h) with small bowel perforation.

Conclusions: Delay in surgical intervention following blunt abdominal trauma may not affect the outcomes of patients with small bowel injuries, such as LOS, ICU LOS, morbidity, and mortality, except bowel resection.