الفهرس 
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Abstract
This descriptive retrospective study was conducted on patients with intestinal and colonic injury in blunt abdominal trauma at Emergency Department, Suez Canal University Hospital in the period from 1st January 2010 to 31st December 2010.
Total patients admitted to ER in Suez Canal University Hospital were 21435 patients from 1st January 2010 to 31st December 2010 while trauma was the cause of admission in 13560 patients (63.26%) and localized blunt trauma to the abdomen was present in 248 patients and intestinal and colonic injury was present in 31 patients with incidence rate 12.5% in all blunt abdominal trauma patients.
Mechanism of blunt abdominal trauma was road traffic accident in 23 patients (74.2%) , fall from height in 7 patients (22.5%) and one patient was assaulted (direct blow) (3.2%).
The age range from 4 years to 65 years with a mean age of 34.5 ± 14.4 years and there were male 22 patients (70.9%) and female were 9 patients (29.1%). The male to female ratio was 2.3:1.
As regard associated injuries in patients with blunt intestinal and colonic trauma, associated extra abdominal injuries were present in 18 patients (58.06%) and associated abdominal injuries were present in 24 patients ( 77.42%).
Extra abdominal injuries were in the form of chest trauma (fracture ribs, haemothorax, pneumothorax and lung contusion) in 12 patients (38.71%) while head injury was in 2 patients (6.45%) and long bone fractures were in 6 patients (19.35%) and soft tissue injury was in one patient (3.22%).
Associated abdominal injuries were in 24 patients (77.42%). This associated abdominal injury was in the form of injury to spleen in 9 patients (29.03%) and injury to liver in 9 patients (29.03%) and diaphragmatic injury in 1 patient (3.23%) and injury to the kidney was in 2 patients (6.45%) and injury to pancreas was in 3 patients (9.67%) and injury to stomach was in 3 patients (9.67%) and injury to mesentery was in 5 patients (16.13%).
As regard clinical assessment of the patients with blunt intestinal and colonic injury at time of admission to ER in the form of shock was in 14 patients (45.16%) usually this high % due to associated liver, spleen or chest injury. Abdominal tenderness was in 29 patients (93.54%) and distension in 6 patients (19.35%) , peritoneal signs and generalized abdominal rigidity was in 11 patients (35.48%) and one patient was difficult to assess clinically due to deep coma with severe head injury.
Diagnostic modalities used in diagnosis of blunt intestinal and colonic trauma. US done to all patients (100.0%). US detect only Free intraperitoneal air suggesting bowel perforation in 13 patients only (41.9%) which missed 18 patients (58.1%) to diagnose intestinal and colonic injury. Chest X-ray and Abdominal X-ray done to all patients (100%) revealed only air under diaphragm in 5 patients (16.13%) which missed 26 patients (83.87%). CT was done to 17 hemodynamically stable patients and demonstrated variable grades of intestinal and colonic injury. Comparing to pre-operative CT grading of intestinal and colonic injury and intra-operative findings CT was accurate in 12 patients (70.6%) and under estimated in 5 patients (29.4%).
Anatomic location of small intestinal injury was based on the most accurate assessment by laparotomy. Small intestinal injury was found in 22 cases. Duodenal injury in one patient (1/22=4.54%), duodenojejunal flexure in 9 patients (9/22=40.91%), jejunoileal in 4 patients (4/22=18.18%), terminal ileum in 6 patients (6/22=27.27%) and scattered in 2 patients (2/22=9.1%).
Anatomic location of colonic injury was based on the most accurate assessment by laparotomy. Colonic injury was found in 9 cases. In our study, we found sigmoid colon injury in 5 cases (5/9=55.55%), descending colon in 3 cases (3/5=33.33%) and ascending colon in one patient (1/9=11.11%).
All 31 patients were explored. The different surgical procedures performed for the injured intestinal and colonic injury included one or more of the following:- primary repair in 6 patient (19.35%), resection and anastomosis in 25 patients (80.65%), colostomy in 9 patients (29.03%).
18 patients (58.06%) of 31 patients (100%) developed complications. These were in the form of chest infection and ARDS in 15 patients (48.38%) , pyrexia in 16 patients (51.61%), post operative internal hemorrhage in one patient (3.23%) and wound infection in 4 patients (12.9%), and Intra-abdominal abscess in 4 patients (12.9%)
prevalence of intestinal and colonic injury in blunt abdominal trauma.
intestinal and colonic injury = 31/248 = 12.5%
small intestinal (duodenum–jejunum–ileum) = 22/248 = 8.87%
colonic injury = 9/248 = 3.6%
7 patients died (22.58%). Five patients (16.13%) died from causes directly related to associate head and chest injury. while 2 patients (6.45%) died from sever sepsis leading to septic shock and death.