Stomach duodenum and small intestine

Different mechanisms of blunt gastrointestinal trauma lead to diverse patterns of injury. Mortality can range from 10 to 30 per cent. Punctate or slit-like perforations usually occur at the antimesenteric border, and are caused by a sudden increase in intraluminal pressure while closed loops are formed. Alternatively, the bowel can be crushed against the vertebral column. In this case, the bowel wall is locally contused and lacerated. Sometimes the mesentery is injured as well. Complete avulsion of the mesentery root, although uncommon, may lead to early death from hemorrhage (Dauterive.efa/ 1985). Hemorrhagic shock is associated with acute circulatory and functional changes of the gastrointestinal mucosa ( Haglund 1986).

Duodenal lesions are particularly troublesome. Although the duodenum is reasonably well protected in the retroperitoneum, its relatively fixed position makes it vulnerable to injury. Combinations with pancreatic injury are not uncommon, particularly in penetrating trauma. Owing to its location, duodenal injury may be missed initially; this leads to ongoing leakage or hemorrhage in the retroperitoneal space, with subsequent infection. At the time that the infection is discovered, sepsis may already have set in.

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