The small intestine occupies a large portion of the middle and lower abdominal regions, making it more prone to injury. Small intestine injury can often lead to early signs of peritonitis, so diagnosis is generally not difficult. In some cases, however, patients may not exhibit signs of peritonitis because the intestinal perforation is small or the opening is temporarily sealed by food debris, fibrin, or protruding mucosa. Pneumoperitoneum occurs in only a minority of patients with small intestine perforation, so its absence does not rule out the possibility of a perforation.
Once small intestine injury is diagnosed, surgical treatment is usually required whenever conditions permit. During surgery, the entire small intestine and its mesentery should be examined systematically and thoroughly. Even small mesenteric hematomas should be incised and inspected to avoid missing small perforations. The primary surgical approach is simple repair, typically performed using interrupted transverse sutures to prevent postoperative luminal narrowing.
Small bowel resection with anastomosis is indicated under the following circumstances:
- The perforation is large or the edges of the bowel wall are severely damaged.
- Multiple perforations or severe contusions are present in a short segment of the intestine.
- Most or all of the bowel segment is transected.
- A large hematoma or compromised blood supply exists in the bowel segment.
- Mesenteric injury or a significant mesenteric hematoma is impairing blood flow to the bowel wall.