Traumatic rupture of the ileum

Abstract

Three cases of patients who sustained rupture of the ileum following blunt trauma to the abdomen are reported. The onset of symptoms was delayed for a period which varied between 5 and 12 hours after the injury. As so many of these patients are either asymptomatic or have minimal symptoms for the first 6 hours after the injury it might be advisable to admit all cases of abdominal injury to hospital for observation. Laboratory investigations of the haemoglobin, white-blood count, and serum amylase contributed nothing to the early diagnosis of the condition. Plain radiographs of the abdomen show gas under the diaphragm in only 34 per cent of cases of traumatic rupture of the ileum. Needle aspiration of the abdomen for liberated intestinal contents was not carried out in this series. In other series this procedure was found to be accurate in 90 per cent of cases of traumatic rupture of the small bowel. This is the only investigation which can be regarded as making a useful contribution to the early diagnosis of the condition. Laparotomy was carried out between 5 and 15 hours after the injury. There was gross contamination of the peritoneal cavity by intestinal contents. This was due in all 3 cases to a single laceration on the antimesenteric border of the bowel. The lacerations were situated at distances varying between 15 and 22.5 cm. from the ileocaecal valve and were between 1.3 and 2.5 cm. in diameter. These were closed using two layers of chromic catgut. The peritoneal cavity was washed out with saline and Noxyflex. The death of 1 patient in the series occurred 13 hours after the injury and was due to a myocardial infarct. The mortality-rate of 33 per cent for the series is similar to that described in other reports.