Incidence, outcomes and effect of delayed intervention in patients with hollow viscus injury due to major trauma in the Northern region of New Zealand.

BACKGROUND: Patients with hollow viscus injury (HVI) are often a cause for diagnostic uncertainty. The incidence and outcomes of patients suffering hollow viscus injury secondary to major trauma have not been previously described in New Zealand. These metrics are important to guide quality improvement and resource allocation. The aim of our study is to define the incidence, outcomes and effect of delayed intervention on patients admitted to hospital with hollow viscus injury secondary to blunt abdominal trauma in the Northern region of New Zealand. METHODS: A 4-year multicentre retrospective study was performed in the Northern region of New Zealand between 1 July 2015 and 30 June 2019. A primary cohort of patients with confirmed hollow viscus injury secondary to blunt abdominal injury, who underwent a laparotomy, were assessed. The primary outcome measures were incidence, 30-day mortality and morbidity. Secondary outcomes included the effect of timing of surgical intervention. RESULTS: The incidence of hollow viscus injury in the region was 2.03 per 100 000. The 30-day mortality rate was 5% and the 30-day morbidity rate was 82%. Immediate surgical intervention was carried out in 36%, early surgical intervention in 56% and delayed surgical intervention in 8%. CONCLUSION: The incidence of hollow viscus injury is in keeping with similar studies, but with lower mortality and higher morbidity. The rate of immediate or early surgical intervention was high. These findings are important to clinicians managing patients with major trauma and those involved in planning and allocation of resources.

Blind Pouch Syndrome in Gastrojejunostomy.

Blind pouch syndrome is a rare complication of a gastrojejunostomy. Its presentation may differ from blind pouches at other locations in that a small pouch can cause significant symptoms of mechanical obstruction before it is large enough to develop bacterial overgrowth. The effect of a small pouch may be overlooked at endoscopy and a high clinical index of suspicion is required. Here we present a case report of Gastrojejunostomy Blind Pouch Syndrome to highlight this clinically distinct entity.