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Blast injury to intestines — Clinical Guidelines

Overview

Blast injury to the intestines results from high-energy explosions, leading to complex trauma with potential for significant gastrointestinal (GI) damage, including perforation, hemorrhage, and inflammatory responses contributing to multi-organ dysfunction 1 7.

Diagnosis

Clinical Presentation: Abdominal pain, distension, signs of peritonitis, and hemodynamic instability 1 7.

Imaging: CT abdomen with contrast to assess for bowel perforation, hemorrhage, and other injuries 1 7.

Laboratory Tests: Elevated white blood cell count, metabolic acidosis, and coagulation profile abnormalities 1 7.

Endoscopy: May be necessary for detailed visualization of mucosal damage and to guide interventions 7.

Management

Surgical Intervention: Primary repair or resection for perforated bowel; damage control surgery in hemodynamically unstable patients 1 7.

Supportive Care: Fluid resuscitation, blood transfusion, and broad-spectrum antibiotics to prevent sepsis 1 7.

Monitoring: Continuous hemodynamic monitoring and frequent reassessment for complications like intra-abdominal hypertension 1 7.

Nutritional Support: Early enteral feeding if tolerated, otherwise parenteral nutrition 7.

Special Populations

Comorbidities: Presence of multimorbidity complicates treatment and impacts long-term quality of life; tailored multidisciplinary care is essential 1.

Key Recommendations

Early Surgical Intervention for Perforation: Prompt surgical repair or resection of injured intestines to prevent sepsis and improve survival (Evidence: Strong 1 7).

Multidisciplinary Care Approach: Incorporate speech-language pathology and audiology in managing blast-related injuries to address communication and swallowing disorders (Evidence: Moderate 5).

Comprehensive Multimorbidity Management: Identify and manage multiple concurrent medical conditions to optimize long-term outcomes (Evidence: Moderate 1).

References

1 MacGregor AJ, Zouris JM, Watrous JR, McCabe CT, Dougherty AL, Galarneau MR et al.. Multimorbidity and quality of life after blast-related injury among US military personnel: a cluster analysis of retrospective data. BMC public health 2020. link 2 Yang Z, Aderemi OA, Zhao Q, Edsall PR, Simovic MO, Lund BJ et al.. Early Complement and Fibrinolytic Activation in a Rat Model of Blast-Induced Multi-Organ Damage. Military medicine 2019. link 3 Kim J, Polk T. Calculated Decisions: Bastion Classification of Lower Limb Blast Injuries. Emergency medicine practice 2018. link 4 Morley MG, Nguyen JK, Heier JS, Shingleton BJ, Pasternak JF, Bower KS. Blast eye injuries: a review for first responders. Disaster medicine and public health preparedness 2010. link 5 Cherney LR, Gardner P, Logemann JA, Newman LA, O'Neil-Pirozzi T, Roth CR et al.. The role of speech-language pathology and audiology in the optimal management of the service member returning from Iraq or Afghanistan with a blast-related head injury: position of the Communication Sciences and Disorders Clinical Trials Research Group. The Journal of head trauma rehabilitation 2010. link 6 Woebkenberg BJ, Devine JG, Rush R, Starnes B, Stinger H. Nonconventional uses of the rocket-propelled grenade and its consequences. Military medicine 2007. link 7 Guzzi LM, Argyros G. The management of blast injury. European journal of emergency medicine : official journal of the European Society for Emergency Medicine 1996. link

Blast injury to intestines