Prospective evaluation of the role of abdominal echocardiography in the treatment of seriously traumatized patients

The reliability of abdominal ultrasonography (US) in a clinical algorithm for emergency management of blunt trauma was evaluated prospectively. From November 1, 1987 to December 31, 1988, of 111 severe trauma victims admitted to our ICU, 63 were screened according to protocol by US for peritoneal fluid and splenic and/or hepatic injuries. The mean age was 49.6 years. The mean ISS and APACHE II Score was 26.9 and 13.7 respectively. The sensitivity of US for detection of peritoneal fluid was 95%, specificity 97.6%, positive predictive value 95%, negative predictive value 97.6% with a prevalence of 31.7%. For hepatic and splenic injuries instead the results were not as good as for abdominal fluid. Twelve patients underwent laparotomy and 6 with abdominal injuries were successfully treated nonoperatively with serial US examinations. Overall mortality was 12 (19%). No patients died for delayed or missed diagnosis of abdominal injury.     

Primary hepatic artery embolization in pediatric blunt hepatic trauma

Non-operative management of isolated blunt hepatic trauma is recommended except when hemodynamic instability requires immediate laparotomy. Hepatic artery angioembolization is increasingly used for hepatic injuries with ongoing bleeding as demonstrated by contrast extravasation on the CT scan. It is used primarily or after laparotomy to control ongoing hemorrhage. Hepatic angioembolization as part of multimodality management of hepatic trauma is reported mainly in adults, with few pediatric case reports. We describe our institution experience with primary pediatric hepatic angioembolization and review the literature with regard to indications and complications. Two cases (3 and 8 years old), with high-grade blunt hepatic injuries with contrast extravasation on the CT scan were successfully managed by emergency primary hepatic angioembolization with minimal morbidity and avoided laparotomy. To date, the only reports of pediatric hepatic angioembolization for trauma are 5 cases for acute bleeding and 15 delayed cases for pseudoaneurysm. The role of hepatic angioembolization in the presence of an arterial blush on CT in adults is accepted, but contested in a pediatric series, despite higher transfusion rate and mortality rate. We propose that hepatic angioembolization should be considered adjunct treatment, in lieu of, or in addition to emergency laparotomy for hemostasis in pediatric blunt hepatic injury.     

Review of 9 Cases of Diaphragmatic Injury Following Blunt Trauma Chest; 3 Years Experience

Diaphragmatic injuries can occur with both blunt and penetrating trauma which can be associated with herniation of abdominal viscera into the thoracic cavity. Diaphragmatic injuries can occur with blunt trauma chest in 1–7 % of patients. Retrospectively for last 3 years all cases blunt trauma chest admitted to surgery were reviewed and a study of cases of diaphragmatic rupture was done. We analysed 496 patients of blunt trauma chest retrospectively for period of three years. Nine patients have diaphragmatic injuries, all were males, six presented acutely three were chronic. In six patients laparotomy was done, four subcostal and two midline incisions were preferred. In chronic cases thoracotomy was done. Left sided injury predominates and rib fractures are most common associated finding. Diagnosis in majority of cases is made by Computerised tomography scan. Subcostal incision may be used in patients with isolated diaphragmatic injury in acute presentation while thoracotomy is preferred in late cases. Most common morbidity is pulmonary complications     

Paediatric case of a large gastric rupture after a blunt abdominal trauma: Report of a case in a District General Hospital

INTRODUCTIONIsolated gastric rupture after blunt abdominal trauma is rare. In current literature gastric rupture from blunt abdominal trauma ranges between 0.02% and 1.7%. This document reports the first non-motor-vehicle case of an isolated gastric rapture after blunt abdominal injury, which repaired after early diagnosis and aggressive surgical treatment.PRESENTATION OF CASEA 14-year-old boy attended our emergency surgical department after sustained a blunt abdominal trauma following a fall from his bicycle. He presented with pain and left para-umbilical abdominal ecchymoses. Examination revealed subcutaneous emphysema and a palpable abdominal wall dimple.DISCUSSIONRadiological examination with CT scan determined the need for exploratory laparotomy. Operation revealed, extensive rupture of the left lateral border of the rectus abdominus muscle, free intra-peritoneal position of the nasogastric tube with gross spillage of gastric contents and pneumo-peritoneum observed with 7-8cm full thickness rupture of anterior stomach wall, from the lesser towards the greater curvature. Primary, two-layer closure was performed. On the 5th post-operative day he developed gastrorrhagia. He was discharged on the 15th postoperative day.CONCLUSIONWe present this case report focusing on the paediatric patient to illustrate isolated gastric injury in terms of mechanism of injury, clinical presentation, and immediate surgical management.     

Ultrasonographic finding of hemoperitoneum and indication for laparotomy in blunt abdominal trauma]

The usefulness of the ultrasonography (US) for the indication for laparotomy was evaluated. I analyzed 200 blunt trauma patients who took US exams at my emergency center immediately after admission. Ninety-five percent of patients with hemodynamic instability, whose hemoperitoneum was revealed by US, underwent laparotomy. No negative laparotomy was performed in those patients. Only 5.4% of US hemoperitoneum-negative patients with stable hemodynamics required laparotomy because of peritoneal irritation or the evidence of traumatic diaphragmatic hernia. US hemoperitoneum-positive patients with stable hemodynamics were treated selectively, and 46% of such patients eventually underwent laparotomy, depending on findings of serial US, CT, DPL and Intravenous urogram. In two third of them laparotomy was indicated because of serial US showing the appearance or increase in hemoperitoneum. The maximum width of echo free space in Morison's pouch became more than 10 mm in the all exams when the laparotomy was indicated. I believe that US finding of hemoperitoneum should be an integral part of evaluating laparotomy indications in blunt abdominal trauma.     

Isolated Traumatic Gallbladder Rupture

Blunt traumatic injury to the extrahepatic biliary system is a rare event usually recognized on evaluation and treatment of other visceral injuries during laparotomy. Isolated gallbladder rupture secondary to blunt abdominal trauma is even more uncommon, but poses a potential life-threatening surgical emergency. Delay in the diagnosis of the injury for several days due to no or vague symptoms and an insidious course are common. Early diagnosis is essential, as protracted treatment may result in significant morbidity and mortality. We report the case of a patient who suffered an isolated gallbladder rupture due to blunt abdominal trauma from a fall. The subject of isolated traumatic gallbladder rupture is reviewed because of the rarity of this condition and the diagnostic challenges it poses.     

Liver injuries in children: the role of selective non-operative management

INTRODUCTION: This review article on the management of blunt liver injury in children is based on the authors' experience of 311 patients over a 22-year period. MATERIAL AND METHODS: All children presenting to our institution with confirmed blunt liver trauma were studied retrospectively. Hospital folders of 311 patients were analysed. Information was gathered about the clinical presentation, associated injuries, grade of injury, transfusion requirements and haemodynamic stability to examine factors influencing outcome. RESULTS: The age of patients ranged between 3 weeks and 12 years (mean of 7 years). Injuries as a result of motor vehicle accidents (MVAs) were the most common (268; 232 pedestrian and 36 passenger), other causes were falls (26) assaults or child abuse(15), bicycle handle bar injury (2). One hundred and thirty-six patients sustained an isolated hepatic injury and 175 had multiple injuries. Associated injuries included 147 head injuries, 131 fractures, 66 thoracic and 143 intra-abdominal (74 spleen, 45 renal, 4 pancreatic and 4 hollow viscus). Two patients died soon after arrival, 21 underwent laparotomy, 13 of which were liver related, while 288 were treated non-operatively. One hundred and six patients required blood transfusion (mean of 21.3 ml/kg); 30% of the nonoperative group and 100% of the operative group. There were three fatalities from the operative group (1% total mortality), one secondary to a severe, head injury, one liver haemorrhage and one from multi-organ failure DISCUSSION: The vast majority (93%) was successfully treated non-operatively with only 4% coming to liver related laparotomy, complications were lower, transfusions less and the in-hospital occupancy was shorter. Complication rate was 8% and mortality was 1%. CONCLUSION: We confirm the success selective non-operative management of blunt liver trauma as adopted by this institution 20 years ago. It is now proven treatment in an appropriate centre. However, the challenge is to identify the severely injured child early and institute aggressive resuscitation and expedite laparotomy when indicated.     

Rupture of the pericardium with luxation of the heart after blunt trauma

Two multiple trauma patients with total rupture of the pericardium and luxation of the heart into the left pleural cavity after blunt trauma are presented. One of the patients also had rupture of the posterior wall of the left ventricle with abundant bleeding. Both patients had intra-abdominal organ injuries, and emergency laparotomy was the first surgical procedure. The pericardial injury in one patient was diagnosed and treated by immediate thoracolaparotomy, in the other by left thoracotomy within 1 hour after laparotomy: both patients recovered. Awareness of possible pericardial lesions in multiple trauma patients with symptoms of hemodynamic failure is stressed.     

Isolated right diaphragmatic rupture following blunt trauma

Blunt diaphragmatic injuries are usually caused by blunt trauma or penetrating injuries. The diagnosis may be delayed or missed because of the confusing clinical and radiographic findings and the presence of multiple associated injuries. We report the case of an isolated right diaphragm rupture in a 56-year-old man who sustained blunt thoracic trauma after car accident 2 weeks before presentation. No other injuries were detected, and he was subjected to laparotomy. Diaphragmatic rupture is perceived as an emergency entity. The late appearance of such an injury, without other accompanying injuries, is rare and should be in mind by clinicians treating trauma patients who have a delayed presentation after the injury.     

Is delayed laparotomy for blunt abdominal trauma a valid quality improvement measure in the era of nonoperative management of abdominal injuries?

BACKGROUND: Review of hemodynamically stable patients who undergo laparotomy for trauma greater than 4 hours after admission is an American College of Surgeons quality improvement filter. We reviewed our recent experience with patients who underwent laparotomy for trauma greater than 4 hours after admission to evaluate the reasons for delay, and to determine whether they were because of failure of nonoperative management or other causes. METHODS: The registry at our Level I trauma center was searched from January 1998 through December 2000 for patients who required a laparotomy for trauma greater than 4 hours after admission. Of 3,369 admitted blunt trauma patients, 90 (2.7%) underwent laparotomy for trauma, of which 26 (29%) were identified as delayed laparotomies greater than 4 hours after admission. RESULTS: The most common mechanism of injury was motor vehicle crash, the mean Injury Severity Score was 18, and 65% of the patients had significant distracting injuries. Five patients had laparotomy greater than 24 hours after admission. The average time to the operating room in the remaining patients was 8.6 hours. Clinical examination (61%) findings were the most common indication for operation. Gastrointestinal (GI) tract injury was the most common injury associated with delay in laparotomy (58%). CONCLUSION: GI tract injuries are the predominant injury leading to delayed laparotomy for blunt trauma (58%). Failed nonoperative management of solid organ injuries occurred less frequently (15%). Future efforts should concentrate on earlier identification of GI tract injury. Delayed laparotomy for blunt abdominal trauma is a valid quality improvement measure.     

严重多发脏器损伤的临床特点及诊治

目的探讨严重多发脏器损伤的临床特点和诊治方法.方法对1988～1998年间收治的合并有闭合性腹内脏器损伤的严重多发伤、ISS大于16的165例患者进行回顾性分析.结果3个或3个以上部位多发伤占28.5%.63例有腹内多脏器损伤.腹腔穿刺是确诊的主要检查手段,部分病例选用了腹部B超和CT,3项诊断检查阳性率均在90%以上.全组漏诊腹内伤21例(12.7%),死亡29例(17.6%).死亡病例平均ISS41.6,明显高于非死亡病例24.8(t=15.21,P<0.01).结论严重多发伤病例应常规行诊断性腹腔穿刺,酌情选择腹部B超和CT等检查,以排除腹内脏器损伤.对全身多发伤并存腹内伤的病例,要根据伤情确定急救处理顺序.剖腹手术中要注意多脏器损伤.ISS大于40提示预后不良.     

Features and outcomes of patients with grade IV renal injury

OBJECTIVE

To evaluate the clinical features and outcomes of patients who presented with grade IV renal trauma to our urban level I trauma hospital and to further refine the absolute indications for exploration and determine the outcomes of conservative management.

PATIENTS AND METHODS

In all, 77 patients with grade IV traumatic renal injuries presented to our emergency department between October 1997 and October 2006. A prospective trauma database including these patients was analysed to determine the patterns of injury, operative outcomes and complications.

RESULTS

A quarter of the patients had gunshot injuries, 9% had stab injuries, and 66% had blunt traumas. In all, 36% of patients required surgical exploration to treat associated non‐urological injuries. There was no or microscopic haematuria in 29% of the patients. Of the 32 patients who underwent renal exploration, 63% (20/32) underwent renorrhaphy and 37% (12/32) underwent nephrectomy. In multivariate analyses, only gunshot injury, surgery for non‐urological injury, and volume of blood transfused were significantly associated with the need for renal exploration (P = 0.015, P = 0.041, and P = 0.032, respectively). The renal complication rate was higher in patients managed conservatively vs those who underwent surgical exploration, but this was not statistically significantly different (28% vs 13%, P = 0.2). Hospital stay was longer after renal exploration than after conservative management at a median of 12 days vs 7 days (P = 0.01).

CONCLUSIONS

While almost all patients with penetrating injury require renal exploration, only 20% of those with blunt trauma do. Patients with no renal injuries and/or haemodynamic instability are more likely to require exploration. Finally, the rate of complications was not statistically different according to management type (conservative vs renal exploration).     

Traumatic `degloving' of the colon in blunt abdominal injury

We describe two cases of traumatic `degloving' of the colon in blunt abdominal trauma. This is an extremely rare injury with the potential to present late. The mechanism of injury appears to be a combination of focal blunt abdominal trauma associated with a shearing force. The potential diagnostic dilemma posed by colonic `degloving' is outlined and following review of the literature we conclude that CT scanning is the most reliable way of detecting such injuries, if emergency laparotomy is not indicated.     

Diagnosis of Bowel Injuries from Blunt Abdominal Trauma

Abstract Background: Patients with bowel injuries resulting from blunt abdominal trauma show no reliable clinical or radiologic signs on initial examination. The mechanism of injury is the only element of some diagnostic value. Intestinal injury may be evaluated by ultrasonography (US), plain abdominal radiographs, computed tomography (CT), and diagnostic laparoscopy. This paper is a retrospective study of diagnostic procedures used in 45 consecutive patients with bowel injuries who presented at our center between October 1996 and December 2001. Patients and Methods: Of 45 patients (mean age 40 years), nine suffered isolated bowel injuries and 36 presented with concomitant injuries. The mechanism of trauma was traffic accident in 30 of 45 patients (in 16 of these 30 patients compression by a seat belt), strong blow to the abdomen in eight, fall from a height in five, and other causes in two patients. US was done in 43 of 45 patients, plain abdominal radiographs in 22, CT in six, peritoneal lavage in one, and diagnostic laparoscopy in one. Results: 37 of 43 patients were evaluated by US immediately upon arrival; in four patients there was a delay in diagnosis of 1 day, and in two patients a delay of several days. At initial sonography, free intraperitoneal fluid was identified in 32 of the 43 patients; in most of them (n = 15) the amount of free fluid was rather small. Free fluid was absent in eleven of 43 patients; yet seven of these eleven patients demonstrated free fluid upon repeat examination.In nine of 32 patients, an increased amount of free fluid was identified upon repeat examination. Two of 43 patients, evaluated 3 and 9 days after arrival, respectively, showed dense intraperitoneal fluid, suggestive of peritonitis. US identified intestinal injuries in 14 of 43 patients; in all of them, the diagnosis was established upon repeat examination or delayed initial examination. Radiographs were performed in 22 of 45 patients (18 of them suffering perforation) and verified the pneumoperitoneum in nine of 18 patients with perforation. CT scanning identified intestinal injury in four of six patients. 17 of 45 patients were operated immediately in the Surgical Emergency Unit, 15 patients in the first 24 h, eight patients 2 days after admission, and five patients > 2 days (max. 9 days) after admission. In our series of 45 patients, there were four deaths, and only two (4.4%) were associated with bowel injury. Conclusion: In patients presenting with a typical mechanism of trauma and an abdominal bruise, plain radiographs should be taken in addition to initial US to identify the presence of free air. In patients with negative radiologic and US findings and in those demonstrating a small quantity of free fluid, US scanning should be repeated soon after the initial evaluation and, if necessary, a CT scan should be taken. The use of laparoscopy is indicated in unclear cases. According to our experience, a judicious and timely decision for laparotomy can only be based on the combination of the mechanism of injury, clinical picture, and results of properly planned diagnostic tests.     

The incidence,spectrum and outcomes of traumatic bladder injuries within the Pietermaritzburg Metropolitan Trauma Service

IntroductionThe purpose of this study is to provide a comprehensive overview of the incidence, spectrum and outcomes of traumatic bladder injury in Pietermaritzburg, South Africa, and to identify the current optimal investigation and management of patients with traumatic bladder injuries.MethodsThe Pietermaritzburg Metropolitan Trauma Service (PMTS) trauma registry was interrogated retrospectively for all traumatic bladder injuries between 1 January 2012 and 31 October 2014.ResultsOf 8129 patients treated by the PMTS over the study period, 58 patients (0.7% or 6.5 cases per 1,000,000 population per year) had bladder injuries, 65% caused by penetrating trauma and 35% by blunt trauma. The majority (60%) were intraperitoneal bladder ruptures (IBRs), followed by 22% extraperitoneal bladder ruptures (EBRs). There was a high rate of associated injury, with blunt trauma being associated with pelvic fracture and penetrating trauma being associated with rectum and small intestine injuries. The mortality rate was 5%. Most bladder injuries were diagnosed at surgery or by computed tomography (CT) scan. All IBRs were managed operatively, as well as 38% of EBRs; the remaining EBRs were managed by catheter drainage and observation. In the majority of operative repairs, the bladder was closed in two layers, and was drained with only a urethral catheter. Most patients (91%) were managed definitively by the surgeons on the trauma service.ConclusionTraumatic bladder rupture caused by blunt or penetrating trauma is rare and mortality is due to associated injuries. CT scan is the investigative modality of choice. In our environment IBR is more common than EBR and requires operative management. Most EBRs can be managed non-operatively, and then require routine follow-up cystography. Simple traumatic bladder injuries can be managed definitively by trauma surgeons. A dedicated urological surgeon should be consulted for complex injuries.     

Gall bladder injuries as part of the spectrum of civilian abdominal trauma in South Africa

BACKGROUND: Trauma to the gall bladder is rare, but when missed or improperly managed it may be associated with significant morbidity. The aim of the present study was to review the management and outcomes of gall bladder trauma in a trauma centre. METHODS: Forty-three patients with gall bladder injury due to abdominal trauma were reviewed over a 3-year period. Surgical management, associated injuries, morbidity and mortality rates were determined. RESULTS: Among 1242 patients undergoing laparotomy for acute trauma, 43 patients (3.46%) with gall bladder injuries were identified. Forty patients sustained penetrating injuries (37 with gunshot wounds and three with stab wounds), and three patients suffered from blunt trauma. All patients with gall bladder injury underwent abdominal exploration because of associated intra-abdominal injuries. Thirty-six patients were treated with cholecystectomy, four patients underwent primary suture repair of the gall bladder perforation, while three patients with gall bladder injury were treated without any surgical intervention at laparotomy. No complications could be attributed to the gall bladder trauma or surgery. CONCLUSION: Cholecystectomy is the preferred procedure of choice for gall bladder injuries and is associated with no morbidity.     

Abdominal trauma: a disease in evolution

BACKGROUND: The last decade has seen many changes in the way we investigate and manage abdominal injuries. This study assessed the pattern of abdominal injury and its investigation in patients admitted to a major trauma centre. METHODS: A retrospective registry review of all adult trauma patients admitted to Liverpool Hospital between January 1996 and December 2003 was undertaken. All adult trauma patients were included, identifying mechanism of injury, injury severity score, abbreviated injury score for the abdomen, investigations and intervention. The study period was divided (period 1 from 1996 to 1999, period 2 from 2000 to 2003) and the two periods compared to assess change. RESULTS: The study involved 1224 patients with abdominal injuries. Of these, 969 (79%) were a result of blunt trauma. The main causes were road accidents (61%), interpersonal violence (24%) and falls (7%). Penetrating injury increased from 16% to 25% between the two periods. There were 1274 intra-abdominal injuries, made up of 607 solid organ (liver (n = 220, 36%), spleen (n = 195, 32%), renal (n = 144, 24%) ), 291 hollow viscus (small bowel (n = 160, 55%), large bowel (n = 104, 36%) ) and 168 vascular. Four hundred and thirty-six (36%) patients underwent laparotomy, 65% for blunt trauma. Between the two periods there was a 46% decrease in the use of diagnostic peritoneal lavage, with a 40% increase in computed tomography and 325% increase in focused assessment with sonography for trauma. CONCLUSIONS: This study defined abdominal injury pattern and identified a significant shift in mechanism of injury and abdominal investigation at a major trauma centre during an 8-year study period. Abdominal trauma is indeed a disease in evolution.     

Management of penetrating and blunt diaphragmatic injury

The past 5 years' experience with diaphragmatic injuries at the University of Texas Health Science Center in San Antonio was reviewed to refine the clinical signs and appropriate treatment. During this period 102 patients were treated. Ninety-three patients incurred penetrating trauma to the diaphragm and nine patients suffered blunt trauma. Chest X-rays were normal in 40 patients, a hemo- and/or pneumothorax was present in 57, herniated abdominal viscera in four, and free air in one. Peritoneal lavage was positive in six of seven patients with blunt diaphragmatic injury, but was falsely negative in two of five patients (20%) with penetrating diaphragmatic injury. Eighty-nine patients (87%) experienced 137 associated injuries (excluding hemo- and/or pneumothorax). Nine patients (8.8%) had an isolated diaphragmatic injury. Four patients (4%) had a diaphragmatic injury associated with only a hemo- and/or pneumothorax. All patients, except for three with injuries recognized late, were operated upon immediately. Two patients had a missed diaphragmatic injury at initial laparotomy. There was one death in the series from a consumption coagulopathy. It was concluded that injuries to the diaphragm should be suspected in all patients with severe blunt torso trauma or with penetrating injuries near the diaphragm. Because of the nonspecificity of X-rays and the 20% false negative rate for peritoneal lavage, we believe that missed injuries and morbidity can be minimized by immediate laparotomy for all patients with abdominal and low thoracic penetrating injuries. Care must be taken not to overlook associated injuries.     

Diagnosis of ruptured diaphragm following blunt trauma: results from 85 cases

Between 1975 and 1990, 85 patients with diaphragmatic rupture following blunt trauma were treated at the Royal Brisbane and Princess Alexandra Hospitals, Brisbane. There were 65 on the left, 17 on the right and three were bilateral. Road trauma was the cause in 88% of cases. In the first 48 h the diagnosis was made by chest X-ray in 51 patients, laparotomy in 22, autopsy in two, emergency room thoracotomy, ultrasound and pneumoperitoneum each in a single patient. Seven patients (8%) had delay in diagnosis greater than 48 h ranging from 6 days to 6 months. Diagnosis was subsequently made by pneumoperitoneum (3), chest X-ray (1) and exploratory thoracotomy (1). Two patients presented with a strangulated diaphragmatic hernia 3 and 6 months following an acute admission with blunt chest trauma and urological trauma respectively. During the study period a further five patients presented with an obstructing diaphragmatic hernia. Sixteen patients died (19%), fifteen from associated injuries and one related to the diaphragmatic repair. Ruptured diaphragm should be suspected in patients with severe chest trauma, particularly those requiring positive pressure ventilation, patients with intra-abdominal injuries and those with pelvic fractures. Early recognition and repair results in low morbidity and mortality. Measures that confirmed the diagnosis in patients with delay included repeated chest X-rays and pneumoperitoneum.     

Role of laparoscopy in blunt perforations of the small bowel

Background: The purpose of this study was to determine whether laparoscopy could improve our ability to diagnose and treat perforations of the small bowel. Methods: From 1985 to 2001, among 250 patients admitted for a blunt abdominal trauma, 195 surgical explorations were performed, comprising 42 laparoscopies. On admission, 108 patients underwent an abdominal ultrasonography (US) and 104 a computed tomography (CT). Thirty-nine patients had a blunt small bowel trauma (BSBT) that was explored and/or treated by laparoscopy (n = 15) or celiotomy (n = 24). We compared the patients who underwent emergency surgery (23) and those who were operated on after a mean delay of 51 h. Results: On admission, for detecting free intraperitoneal fluid with a BSBT, the sensitivity of CT was 93.3% and specificity was 13.6%. Regarding the 23 patients who underwent emergency surgery, 8/20 had positive US and 10/15 had positive CT, whereas the 15 celiotomies and 8 laparoscopies indicated BSBT. Regarding the 16 patients who underwent delayed surgery, 9 patients underwent a celiotomy and 7 a laparoscopy; all BSBTs were diagnosed. In searching for BSBT, the sensitivity and specificity of laparoscopy were both 100%, whereas the sensitivity of CT was 83.3% and specificity was 22.2%. Twenty of 23 patients undergoing emergency surgery had bowel suture repair compared to 3/16 after delayed surgery. In contrast, a resection was necessary in 10/12 patients treated after a delay compared to 2/17 operated in emergency. Five BSBTs were sutured by laparoscopy, whereas 10 required conversion. Laparoscopy avoided celiotomy in 15 cases. There were no deaths and no enterostomy. Conclusion: In hemodynamically stable patients with blunt abdominal trauma, laparoscopy safely and effectively identifies small bowel injuries. Early recognition of these injuries and timely surgical treatment offer the best prognosis.