Explorative laparoscopy/laparotomy in the management of relevant blunt abdominal trauma

N. Campanile, A. Miftaroski, M. Menth, B. Egger

Objective

Trauma is the fourth overall cause of death in the US and abdominal injuries contribute to a large extent of these deaths. The initial management of blunt abdominal trauma is challenging and requires a multidisciplinary team approach. After initial resuscitation and stabilization of such patients, blood analysis and CT-scan needs to be performed. The decision to go for an exploratory laparoscopy or even laparotomy is not always easily done.

Methods

We present the case of a 62 year old man who was hit on the abdomen and right arm by a falling heavy metal plate at his working place. When he arrived at the emergency department his condition was hemodynamically stable. Laboratory tests showed a Hb of 115 g/L, WBC of 7.5G/L and normal clotting values. An urgently performed thoraco-abdominal CT-scan showed massive free abdominal fluid but no free air as a possible sign for an intestinal perforation. According to the guidelines of ATLS and suspecting a vascular lesion an emergency laparotomy was performed.

Results

On laparotomy an important amount of fresh blood was present with the additional finding of a disrupted ileo-caecal mesentery including the vascular trunk leading to ischemic distal small bowel of 150 cm. Furthermore a small jejunal perforation and a laceration of the right and left Toldt fascia were found. A jejuno-ileo-caecal resection with primary anastomosis and a direct suture of the jejunal perforation was performed. Next day’s second-look laparotomy did not reveal any further lesions especially no further ischemic bowel or colon. Following that the patient suffered from diarrhea due to a transient short-bowel syndrome. Finally he was discharged home in good general conditions after 11 days.

Conclusion

In case of a relevant blunt abdominal trauma and the finding of free abdominal fluid a rigorous trauma management considering the ATLS rules is most important. Even without clear signs of bowel perforation explorative laparoscopy or even laparotomy should be performed in due time in order not to miss any life-threatening lesions.