Blunt XXXX with jejunal injury: a review.

@entity1 @entity146 @entity1661 @entity542 @entity397 @entity1230 @entity3485 @entity490 @entity158 @entity925 @entity4764
Jejunal perforation is relatively common following focal blunt @entity1661 . The mortality rate remains in the region of 30%. Significant factors affecting mortality are therapeutic delay of 24 hours or more, and @entity1230 . The commonest clinical features are @entity490 , @entity925 , and guarding, diminished or absent bowel sounds and signs of @entity3485 . @entity4764 is presented by the @entity1 with an impaired level of consciousness and/or associated remote injuries which may distract the clinician from the abdomen. @entity397 may also occur, and observation should continue for at least 48 to 72 hours with a warning to return immediately if @entity158 recurs. Straight abdominal and chest radiography are of limited diagnostic value, but nevertheless may prove helpful in 50% of cases. All @entity1 with @entity1230 , particularly in the presence of a @entity542 with an impaired level of consciousness should be submitted to diagnostic abdominal paracentesis. A negative result should prompt diagnostic peritoneal lavage. Early diagnosis and @entity146 therapy are essential if the mortality is to be reduced. To this end careful, frequent abdominal assessment should be practiced, with immediate laparotomy if clinical parameters deteriorate, or do not improve over a 12 to 18-hour period.
