HemoChat

Evidence-Based AI Medical Search

← Back to guidelines
Emergency Medicine409 papers

Injury to intestine during surgery

Last edited: 4/14/2026

Overview

Injury to the intestine during surgery can lead to significant morbidity and mortality, often complicating emergency laparotomy procedures. Risk factors include advanced age, frailty, sarcopenia, socioeconomic deprivation, and comorbidities such as ASA status 145.

Diagnosis

  • Clinical Presentation: Abdominal pain, distension, signs of peritonitis, and hemodynamic instability 17.
  • Imaging: CT scans can help identify intestinal injuries and assess the extent of damage 7.
  • Laboratory Tests: Elevated white blood cell count, metabolic acidosis, and electrolyte imbalances may indicate complications 17.

    • Management

  • Surgical Repair: Primary closure or stoma formation depending on the severity and contamination 17.
  • Antibiotics: Prophylactic broad-spectrum antibiotics to prevent infection 17.
  • Fluid Resuscitation: Aggressive fluid management to maintain hemodynamic stability 17.
  • Nutritional Support: Early enteral or parenteral nutrition as needed 17.

    • Special Populations

  • Elderly: Higher risk of complications; frailty and sarcopenia significantly impact outcomes 14.
  • Comorbidities: ASA status and socioeconomic deprivation influence long-term mortality 15.

    • Key Recommendations

  • Assess Frailty and Sarcopenia: Regularly evaluate patients for frailty and sarcopenia to predict postoperative outcomes and tailor management strategies (Evidence: Moderate 14).
  • Utilize Risk Prediction Tools: Employ tools like the National Emergency Laparotomy Audit (NELA) risk score for comprehensive risk stratification (Evidence: Moderate 2).
  • Enhance Communication Protocols: Implement directed, closed-loop communication in the operating theatre to improve team performance and reduce errors (Evidence: Moderate 38).
  • Consider Socioeconomic Factors: Account for socioeconomic deprivation in risk assessment and patient care planning (Evidence: Moderate 5).
  • Multidisciplinary Training: Engage in multidisciplinary simulation-based training to improve teamwork and patient safety (Evidence: Expert opinion 8).

    • References

    1 Al-Sarireh A, Al-Sarireh H, Ambler O, Hajibandeh S, Hajibandeh S. Synergistic effect of sarcopenia and ASA status in predicting mortality after emergency laparotomy: a systematic review and meta-analysis with meta-regression. Updates in surgery 2025. link 2 Barazanchi AWH, Bhat S, Park B, Zeng I, MacFater W, Xia W et al.. Long-term accuracy of the National Emergency Laparotomy Audit risk score: Analysis of the impact of comorbidities on mortality 5 years after emergency laparotomy. The journal of trauma and acute care surgery 2025. link 3 Lee H, Merry AF, Woodward-Krohn R, Weller JM. Use and effectiveness of directed, closed-loop communication in the operating theatre: mixed methods analysis of simulated clinical emergencies. British journal of anaesthesia 2025. link 4 Park B, Vandal A, Sulistio E, Bhat S, Welsh F, Eglinton T et al.. Association between frailty, long-term mortality and functional outcomes for older adults undergoing emergency laparotomy. World journal of surgery 2024. link 5 Hajibandeh S, Efstathiou A, Hajibandeh S, Al-Sarireh A, Al-Sarireh H, Duffaydar H et al.. Prognostic significance of socioeconomic deprivation in patients undergoing emergency laparotomy: A retrospective cohort study. World journal of surgery 2024. link 6 Naumann DN, Bhangu A, Brooks A, Martin M, Cotton BA, Khan M et al.. Novel Textbook Outcomes following emergency laparotomy: Delphi exercise. BJS open 2024. link 7 McQuade C, Kavanagh DO, O'Brien C, Hunter K, Nally D, Hickie C et al.. CT-determined sarcopenia as a predictor of post-operative outcomes in patients undergoing an emergency laparotomy. Clinical imaging 2021. link 8 Jowsey T, Beaver P, Long J, Civil I, Garden AL, Henderson K et al.. Towards a safer culture: implementing multidisciplinary simulation-based team training in New Zealand operating theatres - a framework analysis. BMJ open 2019. link 9 Bhavani SS, Abdelmalak B. Nonoperating Room Anesthesia: Anesthesia in the Gastrointestinal Suite. Anesthesiology clinics 2019. link 10 Wilson L, Farooq O. Fire in operating theatres: DaSH-ing to the rescue. Journal of perioperative practice 2018. link 11 Gudnadottir M, Thorsteinsdottir TK, Mogensen B, Aspelund T, Thordardottir EB. Accidental injuries among older adults: An incidence study. International emergency nursing 2018. link 12 Jonker WR, Hanumanthiah D, O'Sullivan EP, Cook TM, Pandit JJ. A national survey (NAP5-Ireland baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in Ireland. Anaesthesia 2014. link 13 Laudanski K, Schwab WK, Bakuzonis CW, Paulus DA. Thermal damage of the humidified ventilator circuit in the operating room: an analysis of plausible causes. Anesthesia and analgesia 2010. link 14 Courtney NM, McCoy EP, Scolaro RJ, Watt PA. A serious and repeatable electrical hazard--compressed electrical cord and an operating table. Anaesthesia and intensive care 2006. link 15 Langslow A. Defending negligence claims. Australian nursing journal (July 1993) 1999. link 16 Ciepichał J, Kübler A. Effect of general and regional anesthesia on some neutrophil functions. Archivum immunologiae et therapiae experimentalis 1998. link 17 Moleski RJ, Easley S, Barash PG, Primer G, Shier NQ, Schrier RI. Control and accountability of controlled substance administration in the operating room. Anesthesia and analgesia 1985. link 18 Vickers MD. Fire and explosion hazards in operating theatres. British journal of anaesthesia 1978. link 19 Scholz DA. The social consequences of accidental injury. Papua and New Guinea medical journal 1976. link

    Original source

    1. [1]
      Synergistic effect of sarcopenia and ASA status in predicting mortality after emergency laparotomy: a systematic review and meta-analysis with meta-regression. — Al-Sarireh A, Al-Sarireh H, Ambler O, Hajibandeh S, Hajibandeh S Updates in surgery (2025)
    2. [2]
      Long-term accuracy of the National Emergency Laparotomy Audit risk score: Analysis of the impact of comorbidities on mortality 5 years after emergency laparotomy. — Barazanchi AWH, Bhat S, Park B, Zeng I, MacFater W, Xia W et al. The journal of trauma and acute care surgery (2025)
    3. [3]
      Use and effectiveness of directed, closed-loop communication in the operating theatre: mixed methods analysis of simulated clinical emergencies. — Lee H, Merry AF, Woodward-Krohn R, Weller JM British journal of anaesthesia (2025)
    4. [4]
      Association between frailty, long-term mortality and functional outcomes for older adults undergoing emergency laparotomy. — Park B, Vandal A, Sulistio E, Bhat S, Welsh F, Eglinton T et al. World journal of surgery (2024)
    5. [5]
      Prognostic significance of socioeconomic deprivation in patients undergoing emergency laparotomy: A retrospective cohort study. — Hajibandeh S, Efstathiou A, Hajibandeh S, Al-Sarireh A, Al-Sarireh H, Duffaydar H et al. World journal of surgery (2024)
    6. [6]
      Novel Textbook Outcomes following emergency laparotomy: Delphi exercise. — Naumann DN, Bhangu A, Brooks A, Martin M, Cotton BA, Khan M et al. BJS open (2024)
    7. [7]
      CT-determined sarcopenia as a predictor of post-operative outcomes in patients undergoing an emergency laparotomy. — McQuade C, Kavanagh DO, O'Brien C, Hunter K, Nally D, Hickie C et al. Clinical imaging (2021)
    8. [8]
      Towards a safer culture: implementing multidisciplinary simulation-based team training in New Zealand operating theatres - a framework analysis. — Jowsey T, Beaver P, Long J, Civil I, Garden AL, Henderson K et al. BMJ open (2019)
    9. [9]
      Nonoperating Room Anesthesia: Anesthesia in the Gastrointestinal Suite. — Bhavani SS, Abdelmalak B Anesthesiology clinics (2019)
    10. [10]
      Fire in operating theatres: DaSH-ing to the rescue. — Wilson L, Farooq O Journal of perioperative practice (2018)
    11. [11]
      Accidental injuries among older adults: An incidence study. — Gudnadottir M, Thorsteinsdottir TK, Mogensen B, Aspelund T, Thordardottir EB International emergency nursing (2018)
    12. [12]
      A national survey (NAP5-Ireland baseline) to estimate an annual incidence of accidental awareness during general anaesthesia in Ireland. — Jonker WR, Hanumanthiah D, O'Sullivan EP, Cook TM, Pandit JJ Anaesthesia (2014)
    13. [13]
      Thermal damage of the humidified ventilator circuit in the operating room: an analysis of plausible causes. — Laudanski K, Schwab WK, Bakuzonis CW, Paulus DA Anesthesia and analgesia (2010)
    14. [14]
      A serious and repeatable electrical hazard--compressed electrical cord and an operating table. — Courtney NM, McCoy EP, Scolaro RJ, Watt PA Anaesthesia and intensive care (2006)
    15. [15]
      Defending negligence claims. — Langslow A Australian nursing journal (July 1993) (1999)
    16. [16]
      Effect of general and regional anesthesia on some neutrophil functions. — Ciepichał J, Kübler A Archivum immunologiae et therapiae experimentalis (1998)
    17. [17]
      Control and accountability of controlled substance administration in the operating room. — Moleski RJ, Easley S, Barash PG, Primer G, Shier NQ, Schrier RI Anesthesia and analgesia (1985)
    18. [18]
      Fire and explosion hazards in operating theatres. — Vickers MD British journal of anaesthesia (1978)
    19. [19]
      The social consequences of accidental injury. — Scholz DA Papua and New Guinea medical journal (1976)
    Share:TwitterRedditLinkedIn

    HemoChat

    by SPINAI

    Evidence-based clinical decision support powered by SNOMED-CT, Neo4j GraphRAG, and NASS/AO/NICE guidelines.

    ⚕ For clinical reference only. Not a substitute for professional judgment.

    © 2026 HemoChat. All rights reserved.
    Research·Pricing·Privacy & Terms·Refund·SNOMED-CT · NASS · AO Spine · NICE · GraphRAG