Traumatismes fermés des organes creux

Injuries to the bowel and mesenteries occur in 3-5% of blunt abdominal traumas. These polymorphic injuries (hematoma, tear, perforation, ischemia) affect preferentially the small bowel and may be responsible for bleeding and peritonitis. A laparotomy must be performed urgently if active bleeding or peritonitis is revealed by the initial examination, but these situations are uncommon. The main diagnostic challenge is to correctly identify lesions that require surgical repair. A diagnostic delay of more than eight hours before surgical repair is associated with increased morbidity and probably mortality. Taking into consideration this risk, the traditional therapeutic approach led to operate all patients with suspected bowel or mesenteric injury. However, this approach leads to a high rate of non-therapeutic laparotomy. A new approach of non-operative management tends to develop in patients hemodynamically stable and without perforation signs. A new approach of non-operative management tends to develop in patients hemodynamically stable and without perforation marks. This attitude, described in several recent studies, can be proposed to nearly 40% of patients. There is however no consensual recommendation on combination of clinical and radiological signs for deciding a safe non-surgical initial treatment. If an initial non-operative management has been decided, a very close monitoring must be set up with repeated clinical examinations and probably control CT scan. Larger multicenter studies are needed to better define the conditions of non-operative treatment.