A 30-year-old woman involved in a car crash is brought into the emergency department. Her blood pressure is 90/60 mm Hg, pulse rate is 120 bpm, and respiration rate is 18 breaths per minute. On peritoneal lavage, she is noted to have free blood in the peritoneal cavity. At the time of exploratory laparotomy, a liver laceration is noted, and there is a 2.5-cm-diameter contusion to an area of small bowel. How should the small-bowel contusion be treated?
Contusion of the small bowel may be larger than apparent and may lead to necrosis and perforation. Contusions of 1 cm or less in diameter may be turned in with mattress sutures. However, larger contusions should be resected. The advantage of a single-layer anastomosis is the speed of performance and the reduced likelihood of compromising the muscularis mucosa.
Transillumination evaluation of hematoma with meticulous hemostasis
Resection of the bowel with single-layer anastomosis
Inversion of the area of contusion with a row of fine nonabsorbable mattress sutures
Resection of the bowel and ileostomy
Trauma