Emergency Laparotomy and Outcomes in Penetrating Small Bowel Perforation in Unstable Patients

Background The purpose of the study was to evaluate the impact of emergency laparotomy (EL) on outcomes of patients who suffered from small bowel perforations following a penetrating mechanism and presented with initial systolic blood pressure (SBP) <90 mmHg. Methods Data from 2012-2014 from the National Trauma Data Bank (NTDB) data set was accessed for this study. All patients who presented with initial SBP <90 mmHg and sustained perforated small bowel injury after a penetrating mechanism and were taken for EL within four hours of the patient’s arrival to the hospital were included in the study. Data were categorized into early group, if the EL was performed within an hour and late group, and if EL was done 1-4 hours of patient arrival to the hospital. Results Out of 360, approximately 89% of patients underwent EL within an hour and 11% of patients underwent EL within 1-4 hours of hospital arrival. The median (IQR) time of the late laparotomy was two (2, 3) hours. After propensity matching, there were no significance differences found between the groups regarding in-hospital mortality (11 (26.8%) vs 8 (19.5%), P = 0.54), total hospital length of stay (median and IQR 20 (17, 25) vs 15 (11, 20), P = 0.117), discharge to home without services (67% vs. 82%, P = 0.28), and post-operative complications. Conclusion EL in perforated small bowel injury in unstable patients needs to be performed as soon as possible. EL performed within the median of two hours’ time may be acceptable in certain circumstances.