2Department of general surgery, CHU Sylvanus Olympio de Lomé, Togo
3Department of radiology, CHU Kara, Togo
Submission: January 02, 2019;Published: February 11, 2019
*Corresponding author: DossouvI Tamegnon, Department of general surgery, CHU Kara, Togo, West Africa
How to cite this article: Dossouvi Tamegnon, Amavi Ayi, Amouzou Efoé-Ga, Dagbe Massaga, et al. The Digestive Tract Injury Secondary to Abdominal
002 Blunt: Diagnosis and Management in Teaching Hospital of Kara (Togo). Open Access J Surg. 2019; 10(3): 555786. DOI: 10.19080/OAJS.2019.10.555786.
Objective: Report our experience of management of bowel injury after abdominal blunt in teaching hospital of Kara (Togo)
Methodology: It’s a retrospective and descriptive study which concerned the patients operated for bowels injury secondary to abdominal blunt in department of general surgery from 1st January 2012 to 30th April 2018.We have studied the etiologies and mechanism, time of admission at hospital, clinic and paraclinical data, treatment and outcomes.
Results: Seventeen patients have registered among which we have 16 men and one woman. The mean age is 28 years old with extremes ranging from 9 to 58 years old. The causes are traffic accident in 15 cases, sports accident in two cases and intentional injury in one case. The admission period is less than 6 hours in 15 cases and greater than 6 hours in two cases. Six patients had presented generalized abdominal defense while eleven patients had localized abdominal defense. The abdominal X-ray performed in fifteen patients had revealed pneumoperitoneum in six cases. The ultrasound revealed hemoperitoneum in two cases and bladder perforation in one case. The computed tomography performed in one case showed hemoperitoneum. All the patients had undergone laparotomy. The lesions were localized on the jejunum in 14 cases, on stomach in one case, sigmoid colon in one case and cecum in one case. The main surgical acts performed were: suture-excision of jejunum in 13 cases and stomach in one case; resection-anastomosis of jejunum in one case; reperitonization of sigmoid colon in one case and cecostomy in one case. Three cases of death were noted due to septic shock.
Conclusion: The bowel injury is rare, but the diagnosis is difficult and done later because of the poverty of the early signs, causing a delay of the management increasing morbimortality’s.
Keywords: Abdominal Blunt; Posttraumatic Bowels; Radiography; Leucocytosis; Laparotomy; General Anesthesia; Banditry; Lesions; Intestinal Perforation; Organ Perforation.
The abdominal blunt is a common emergency. They occur most often in a context of polytrauma and regularly cause damage to the full intraabdominal organs with frequency of spleen and liver. Bowels injuries are rare. Their diagnosis is difficult and later because of the early poor symptomatology, leading to delayed management with consequent high morbidity and mortality. The aim of our study is to report our experience of the management of posttraumatic bowels injuries at Kara University Hospital (Togo).
It is a retrospective and descriptive study, concerning patients operated for bowel injury following an abdominal
blunt, in the department of general surgery at Kara University center (Togo) from 1st January 2012 to 30th April 2018.We have studied the etiologies and mechanism, time of admission at hospital, clinic and paraclinical data, treatment and outcomes.
We have registered 17 patients, of whom 16 were male and one female with a sex ratio (F/H) of 0.06.
The average age was 28 years with extremes ranging from 09 to 58 years. Patients had different profession dominated by the liberal profession (Table 1). Etiologies were represented by traffic accidents in 12 cases, sport accident in one case and voluntary injury in one case. The admission period was six hours in seven cases; six to twenty-four hours in nine cases and more
than forty-eight hours in one case. The admission period was 6
hours in 7 cases; 6 to 24 hours in 9 cases and more than 48 hours
in one case.
The clinical examination consisted of a conserved general
state, a good hemodynamic state and apyrexia in sixteen
cases and a state of septic shock in one case at the entrance; a
localized abdominal defense(periumbilical) in twelve cases and
generalized in five cases at the entrance. With regards to cases
of localized abdominal defense, the evolution was marked by a
generalization of the abdominal pains after 6 hours in 9 patients
and after 48 hours in 2 patients with association of the fever.
X-rays of the abdomen without preparation were carried
out in 15 patients at the entrance which made it possible to
show a pneumoperitoneum in 6 cases. The other two had
benefited from an abdominal ultrasound showing an intraabdominal
effusion, apart from a radiography of the abdomen
without preparation. A patient had benefited from the outset
at the entrance of an abdominal ultrasound that had revealed a
rupture of the bladder. In addition, another patient had first had
an abdominal ultrasound completed a CT scan demonstrating
a peritoneal effusion without lesions of the intraabdominal full
organs. Lastly, one patient had not received any imaging because
he had presented with peritoneal irritation syndrome and septic
shock at the entrance. The blood count was performed in all
patients at the entrance and demonstrated hyperleukocytosis
in 10 cases (in 5 patients with generalized abdominal defense).
During surveillance the remaining seven patients had high
leukocytosis. All patients had laparotomy. Indeed, the 5 patients
who presented a generalized defense at the entrance had been
operated within 6 hours following the trauma while among the
remaining patients, eight had been operated within 24hours,
and two others after 72 hours. Bowels injuries observed were
localized on jejunum (14 cases), the stomach (1 case), sigmoid
(1case), and cecum (1case).
The main surgical gestures were: excision-suture jejunum
in 13 cases; excision-suture the stomach in one case; resectionanastomosis
of jejunum; peritonization of the sigmoid colon in
one case and cecostomy in one case. Moreover, in the patient
who presented a deperitonization of the sigmoid colon, there
was a rupture of the associated bladder dome that required a
cystography plus urinary catheter for 10 days. The outcome
was marked by parietal suppuration in eight cases which had
progressed well under local care. Two cases of incisional hernia
were recorded, which were treated surgically and reinforced
mechanically by placement of a mesh. We had three cases of
death due to septic shock.
Bowels injuries after abdominal blunt are infrequent in
contrast to those of full intraabdominal organs. They represent
3 to 5% of abdominal injury after trauma [1,2]. They are often
encountered in young male subjects because they are exposed to
the phenomena of banditry, criminality, violence and indiscipline.
They sit most often on the hail, but other parts of the digestive
tract may also be interested. Thus, in order of frequency we have
the small, stomach, colon, mesentery [1-4] as observed in our
Several mechanisms can explain the occurrence of intestinal
i. The crush rupture between an external body and the
ii. Bursting by tensioning of a viscera or segment of the
viscera, even at a distance from
iii. the point of impact by the sudden increase in
iv. The stretching’s or dilacerations of the hollow viscera,
their mesentery by the sudden
v. deceleration resulting in hemorrhagic vascular lesions;
vi. The ischemia due to mesenteric lesions that may be
revealed lately [2-5].
In clinical diagnosis, posttraumatic intestinal lesions are
pauci-symptomatic at the beginning especially in the small intestine because of the digestive
content which has an acid pH and little bacterial, explaining the
least peritoneal irritation. On the other hand, later a confirmed
peritonitis will settle with appearance of a generalized abdominal
contracture. This has been the rule in most cases in our series.
Abdominal skin lesions such as skin erosions and bruising are
frequent but not specific, due to the violence of the trauma or the
safety belt, must alert [2-7]. Sometimes the diagnosis is made
only intraoperatively after abdominal trauma went unnoticed
The contribution of imaging is undeniable in the diagnosis of
posttraumatic intestinal lesions. The radiography of the abdomen
without preparation can allow, inconsistently, to highlight a
pneumoperitoneum. It does not often show pneumoperitoneum
of minimal abundance . It has been in six cases in our study.
Massengo et al.  have reported only one case in their series.
The abdominal ultrasound is a little sensitive because it does
not show specific signs of intestinal perforation . The CT
scan is the gold standard to better explore posttraumatic bowel fractures. In fact, abdominal computed tomography can
objectify the indirect signs in favor of an intestinal rupture: an
intraperitoneal effusion without lesions of the intraabdominal
full organs (which we noted in one of our patients); thickening
of the intestinal walls and mesentery (inconstant); interruption
of the intestinal wall in case of complete rupture (inconstant);
pneumoperitoneum, of minimal abundance [8,9]. Thus, in the
absence of pneumoperitoneum in the CT scan, abdominal pain associated with hemodynamic
effusion without full organ injury should suggest intestinal
perforation until proven otherwise [9-11]. In this case an early
exploratory laparotomy is recommended . As a result, CT
scans can be faulty or underestimate intestinal lesions in 25%
of cases, as reported by several authors [13,14]. A delay in the
management of traumatic digestive perforation is derogatory.
Monitoring, repeated clinical examination or even CT scan are
necessary in order to promptly indicate surgical exploration for
Nowadays, with the development of endoscopy, exploratory
laparoscopy can be of great help in the early diagnosis of
posttraumatic intestinal lesions in case of doubt. It has a
diagnostic and therapeutic interest that significantly reduces
morbidity and mortality . Nevertheless, it is indicated in cases
of isolated abdominal contusion but constitutes an invasive
means requiring a general anesthesia. It is contraindicated
in case of hemodynamic instability and polytrauma as in this
case it is associated with brain-encephalic traumas . The
surgical management of these intestinal lesions is a function
of the intestinal segment reached, the period of diagnosis and
the patient’s condition. Early diagnosis and management are a
guarantee of good outcome.
Post-traumatic intestinal lesions are infrequent, most often
due to traffic accidents. The small Intestine particularly the
jejunum is the most affected site. Diagnosis is often difficult and
made late because of the poverty of the symptomatology at the
beginning. However, monitoring, repeated clinical examination
or even CT scan are necessary in order to provide a timely
indication of surgical exploration for hollow organ perforation.