Treatment Modalities of Traumatic Perforation Of Smal Gut And Factors Influencing The Outcome: A Study of 53 Cases

Abstract

Background: Traumatic perforation of the small intestine is a life-threatening surgical emergency, particularly prevalent in low- and middle-income countries where road traffic accidents and interpersonal violence are common. In Bangladesh, abdominal trauma contributes significantly to surgical admissions, with small bowel injuries accounting for 20–25% of intra-abdominal trauma. Despite global advances in trauma care, delayed presentation and limited diagnostic resources continue to hinder optimal outcomes.

Method: A retrospective analysis was conducted on 53 patients with traumatic small bowel injuries admitted to Dhaka Medical College Hospital between July 2002 and June 2003. Inclusion criteria were confirmed small gut injury via laparotomy following either blunt or penetrating trauma. Data were extracted from clinical records, including demographics, mechanism of injury, presentation, operative findings, treatment modalities, and postoperative outcomes. Surgical intervention was guided by clinical deterioration, signs of peritonitis and investigation findings.

Results: Blunt trauma accounted for 56.6% of cases, predominantly from road traffic accidents, while penetrating injuries comprised 43.4%, mainly gunshot wounds. The majority of patients were young males (mean age 34.7 years). Jejunal injuries were most frequent, and early laparotomy within 12 hours correlated with reduced mortality and complications. Overall mortality was 3.77%, with postoperative complications in 41.5% of cases—most commonly wound infection, dehiscence, and anastomotic leakage.

Conclusion: Timely diagnosis, prompt surgical intervention, and comprehensive perioperative care are critical to improving outcomes in traumatic small bowel injuries. This study highlights the need for enhanced emergency response systems, improved diagnostic capabilities, and access to surgical expertise, particularly in resource-constrained settings. Strengthening these areas can significantly reduce morbidity and mortality associated with abdominal trauma.

J Dhaka Med Coll. 2025; 34(2) : 98-110