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Blunt Bowel & Mesenteric Injury Algorithm
Western Trauma Association Critical Decisions Algorithm (Weinberg et al. 2021)
Work through the Western Trauma Association decision points for blunt bowel and mesenteric injury, from CT sign interpretation through operative management and serial evaluation.
Step 1
start
A: Mechanism of Injury Consistent with Possible BBMI
Patient presents with mechanism of injury consistent with potential blunt bowel or mesenteric injury (BBMI).
Signs requiring immediate abdominal exploration (no additional workup needed):
Hemodynamic instability with positive FAST or DPA
Free intraperitoneal air on plain films
Clinical signs of peritonitis
Are any of these signs present?
Clinical Note
High-risk mechanisms include: direct blow (assault, seatbelt "sign"), high-speed MVCs, falls from height, and pedestrian struck. BBMI may be occult with delayed presentation. Maintain high index of suspicion.
Select next step:
Reference
Weinberg JA, et al. Evaluation and management of bowel and mesenteric injuries after blunt trauma: A Western Trauma Association critical decisions algorithm. J Trauma Acute Care Surg. 2021. doi:10.1097/TA.0000000000003327
Node Types
- Start
- Decision
- Action
- Outcome