Traumatic Perforation of the Small Intestine in General Surgery of the CHU Gabriel Touré

Goal: To determine hospital frequency, to describe the clinical and therapeutic aspects and to determine the prognosis. Patients and Methods: This was a retrospective and prospective study carried out in the General Surgery Department from 1 January 1999 to 31 December 2015. Inclusion criteria: 1) open or closed trauma of the abdomen with perforation of the small bowel; 2) clinical examination (abdominal pain, vomiting, fever, abdominal contracture, evisceration, intraoperative findings); 3) paraclinical examinations: pneumoperitoneum on the abdominal X-ray without preparation (ASP) and CT scan. Exclusion Criteria: Abdominal trauma without perforation of the small bowel. We selected 128 patients operated for traumatic perforation of the small bowel. The data was entered and analyzed using Word, Excel 2007 and Statistical Package and Social Science Windows 16.0. The statistical analysis consisted in the calculation of the different frequencies of the variables studied. We used the Khi2 test with significance level P < 0.05. Results: We recorded 119 men versus 9 women and the sex ratio was 13.22. The mean age was 25 years with extremes varying between 15 and 70 years. The majority of patients 57.7% (74 cases) came from the capital, 46.1% (59 cases) were workers, 26.6% (34 cases) of the students. The average time to admission was 29 hours. The main etiologies were road traffic accidents 36.7% (47 cases), stabbing 21.9% (28 cases), firearm 14.8% (19 cases), and sports accidents 10.1% (13 cases). The main clinical signs were abdominal pain 48.44% (62 cases), abdominal contracture 60% (76 cases), disappearance of pre-liver dullness 66.36% (84 cases), and Douglas painful 74.4% (94 cases). The abdominal X-ray without preparation (A.S.P) allowed to objectify a pneumoperitoneum in 45.31% and the scanner a liquid effusion in 45.31% with the associated leHow to cite this paper: Traoré, A., Dembélé, B.T., Diakité, I., Togo, A., Kanté, L., Traoré, A., Konaté, M., Karembé, B., Diarra, A., Bah, A., Sidibé, B., Koné, T., Koné, A., Koné, N., Diango, D.M. and Diallo, G. (2017) Traumatic Perforation of the Small Intestine in General Surgery of the CHU Gabriel Touré. Surgical Science, 8, 414-421. https://doi.org/10.4236/ss.2017.89045 Received: August 8, 2017 Accepted: September 19, 2017 Published: September 22, 2017 Copyright © 2017 by authors and Scientific Research Publishing Inc. This work is licensed under the Creative Commons Attribution International License (CC BY 4.0). http://creativecommons.org/licenses/by/4.0/


Introduction
Traffic accidents are among the main causes of abdominal trauma in both Western and developing countries.The big cities are places of great criminality and banditry with armed attacks.Hail trauma is frequently observed in penetrating wounds but also in bruising of the abdomen.Hail perforations in abdominal trauma have three characteristics that make it difficult to manage: Their symptoms are delayed; It can be masked because of the therapeutics involved, or on the contrary simulated by the association of lesions and their ultimate consequence, which is peritonitis, can lead to the vital prognosis in the healthy subject and to aggravate the prognosis of the polytrauma [1].

Objectives
To determine hospital frequency, to describe the clinical and therapeutic aspects and to determine the prognosis.

Material and Method
This was a retrospective and prospective study carried out in the General Surgery Department from 1 January 1999 to 31 December 2015.Inclusion criteria: 1) open or closed trauma of the abdomen with perforation of the small bowel; 2) clinical examination (abdominal pain, vomiting, fever, abdominal contracture, evisceration, intraoperative findings); 3) paraclinical examinations: pneumoperitoneum on the X-ray of the abdomen without preparation (ASP) and CT scan.Exclusion Criteria: Abdominal trauma without perforation of the small bowel.We selected 128 patients operated for traumatic perforation of the small bowel.The data was entered and analyzed using Word, Excel 2007 and Statistical Package and Social Science Windows 16.0.The statistical analysis consisted in the calculation of the different frequencies of the variables studied.We used the Khi2 test with significance level P < 0.05.

Comments-Discussion
Traffic accidents are among the main causes of abdominal trauma, both in western and developing countries [2].The big cities are places of great criminality and banditry with armed attacks.Trauma to small bowels is frequently observed in penetrating wounds in the abdomen [3].The frequency of 7.85% compared to the total abdominal trauma observed in our study is not different from that of the literature ranging from 6.17% to 12.6% [4] [5] [6].
The juvenile population is exposed to the phenomenon of banditry and the vagaries of traffic, especially in countries where the car fleet increases with a precarious road situation associated with the drivers' incivility.The average age of 25 years of our patients is young and can be superimposed on that of the literature [4] [5] [6] [7] [8].The young age of our patients is explained by the fact that they account for 55.2% of the population, according to the latest demographic survey EDS 2012.We recorded more men than women with a sex ratio = 13.22.This could be related to the socio-occupational activities of man in the working life.Road traffic accidents 36% (47 cases) were the common cause followed by stabbing 21.9% (28 cases) and on fire 14.8% (19 cases).In Nigeria (63.6%) and the United States, firearms have been the cause of traumatic perforation of hail because of their availability, easy access, handling and because of the authorization of weapons in the USA where crime is high [9].Patients were admitted for posttraumatic abdominal pain in 48.44% followed by the penetrating wound in 22.6% of patients.Admission time is an important factor that can greatly influence therapeutic management and prognosis [10].The longer it is, the greater the chance of survival [11].Significant additional mortality was reported for intervention delays beyond the eighth hour [12].It was 29 hours in our study and from 13 hours to 73.2 hours in other African studies [2] [7] [13].This delay in care in Africa may be linked to the lack of pre-hospital medicine, the lack of SAMU teams and the under-provision of civil protection services in our country.The signs of traumatic perforation of the small bowel are those of the peritoneal syndrome.Pain is the major constant functional sign in traumatic perforation of the small bowel [14] [15].It was recorded in more than half of our patients 92.4%.Physical examination is a crucial time in these abdominal traumatized.All our patients showed signs of acute peritonitis, which varies in the literature between 52.63% and 82.2% [4] [7] [16].The sensitivity of SPA is low; It allows the diagnosis of rupture of hollow organs in less than 50% of cases [17].A negative search for gas effusion does not indicate an absence of hollow organ perforation.These images also reveal indirect signs of intraperitoneal effusion (diffuse grisaille, inter-anal spacing, the fuzzy limits of the psoas) [17].We recorded 45.3% (58 cases) of pneumoperitoneum, which is no different from the Senegalese and Indian series [13] [18].Pneumoperitoneum is radiologically indicated by the presence of an inter-hepato-diaphragmatic gaseous crescent which indicates the perforation of an intra-abdominal hollow viscus [17].
The scanner of today is the imaging method of choice for the exploration of the abdomen in emergency.It is reliable in the analysis of associated lesions and in the assessment of hemoperitoneum.Among the computed tomodensitometric signs of an intestinal or mesenteric lesion, there may be mentioned: a thickening of the digestive tract wall, a mesenteric hematoma, a striated appearance of the mesentery or of the colon and an extravasation of the intravenous contrast agent [19] [20] [21].It was performed in 7 patients (5.46%) and identified a pneumoperitoneum in 6 patients (85.7%) associated with splenic contusion in 2 cases.The low rate of achievement of this review is due to the non-availability at all times and its inaccessibility due to the low income of certain patients.