The Mechanism of Intestinal Perforation from Nonpenetrating Abdominal Trauma

Perforation of the bowel from trauma to the intact abdomen occurs with sufficient frequency that most surgeons personally encounter several cases. The high mortality rate, 61% of all reported cases between 1935 and 1942, as cited by Poer and Woliver,1hinges upon delay in operative intervention and closure of the perforation. In our series, when the interval between injury and operation was greater than 12 hours, 4 of 6 patients died; whereas only 2 of 14 died when the interval was less than 12 hours. Certain characteristics of the lesion itself hinder early operation and closure. These characteristics are the size of the lesion, its location, and the apparently insignificant trauma which is sometimes involved. The perforations are usually small. In our 20 cases, the size ranged from 4 mm. to 2 cm. in the 10 instances in which size was recorded exactly, and the size was described as