Surgical treatment and outcome after delayed diagnosis of blunt XXXX .

@entity1 @entity292 @entity733 @entity204 @entity130
OBJECTIVE: To review our experience of 18 @entity1 with @entity130 after @entity130 , the diagnosis of which had been delayed for more than 24 hours. DESIGN: Retrospective study. SETTING: Teaching hospital, Taiwan, R.O.C. SUBJECTS: 18 @entity1 who presented with @entity130 between January 1986 and December 1995. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The reasons for the delay were: injuries not found during the first operation (n = 6), @entity1 had not sought medical help (n = 6), and injuries treated conservatively at local hospitals (n = 5). There was one delay in our department because the @entity1 lost consciousness. 12 @entity1 were treated by pyloric exclusion with no @entity204 (one duodenal @entity292 and 3 @entity733 ). The other 6 had various operations including pancreaticoduodenectomy, jejunostomy, and gastrostomy, with six complications and one death, giving an overall mortality of 6% and morbidity of 50%. Three @entity1 developed delayed extensive @entity733 and all three were treated successfully by laparostomy. 16 of the 18 @entity1 required enteral feeding through a jejunostomy. CONCLUSIONS: Though the complication rate was high, the use of pyloric exclusion and a feeding jejunostomy kept the mortality low. Enteral nutrition should be started early. Laparostomy is a good way to manage @entity733 . To avoid delay, @entity1 at risk of @entity130 should be evaluated early by experienced @entity130 surgeons and any central retroperitoneal haematoma should be explored during the initial laparotomy.
