둔상에 의한 위장관 파열의 진단

Blunt abdominal injury frequently presents diagnostic difficulties, especially with asso ciated bowel perforation. The diagnosis may be delayed, resulting high morbidity and mortality. A retrospective analysis of 48 patients with bowel perforation from blunt trauma between May 1989 and September 1996 was performed. The sex distribution was 34 males and 14 females with a ratio of 2.4:1, and the highest incidence was found in the 3rd, 4th and 5th decades(77%). The most common cause of injury was traffic accident(77%). The most valuable diagnostic method of bowel perfora tion was clinical examinations including tenderness, rebound tenclerness, and abdominal wall rigidity. The sites of perforation were jejunum in 35 cases, ileum in 17 cases, and colon in 4 cases The operation method was primary closure, resection and anastomosis. The associated injuries were long bone fracture, rib fractures, liver laceration, and spleen rupture. The most common postoperative complications were wound infection and ARDS. The mortality rate was 8.3%(4 cases). The most common cause of death was hypovolemic shock due to other associated injuries. We concluded that the most frequent diagnostic method of bowel. Perforation from blunt abdominal trauma is clinical examinations, and a high index of suspicion, especially in multiple injured patients, is an important, aspect of effective early diagnosis of bowel perforation. '