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We hypothesized that patients with intra\u2010abdominal adhesions from prior laparotomy would be subjected to visceral sheering deceleration forces and increased risk for bowel and mesenteric injury following blunt abdominal trauma.\n<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>We performed a multicenter retrospective cohort analysis of 267 consecutive adult trauma patients who underwent operative exploration following moderate\u2010critical (abdominal injury score 2\u20135) blunt abdominal trauma, comparing patients with prior laparotomy (<jats:italic>n<\/jats:italic>\u2009=\u200931) to patients with no prior laparotomy (<jats:italic>n<\/jats:italic>\u2009=\u2009236). Multivariable regression was performed to identify predictors of bowel or mesenteric injury.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>There were no significant differences between groups for injury severity scores or findings on abdominal ultrasound, diagnostic peritoneal aspirate\/lavage, pelvic radiography, or preoperative CT scan. The prior laparotomy cohort had greater incidence of full thickness bowel injury (26 vs. 9%, <jats:italic>p\u2009<\/jats:italic>=\u20090.010) and mesenteric injury (61 vs. 31%, <jats:italic>p\u2009<\/jats:italic>=\u20090.001). The proportion of bowel and mesenteric injuries occurring at the ligament of Treitz or ileocecal region was greater in the no prior laparotomy group (52 vs. 25%, <jats:italic>p\u2009<\/jats:italic>=\u20090.003). Prior laparotomy was an independent predictor of bowel or mesenteric injury (OR 5.1, 95% CI 1.6\u201316.8) along with prior abdominal inflammation and free fluid without solid organ injury (model AUC: 0.81, 95% CI 0.74\u20130.88).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Patients with a prior laparotomy are at increased risk for bowel and mesenteric injury following blunt abdominal trauma. The distribution of bowel and mesenteric injuries among patients with no prior laparotomy favors embryologic transition points tethering free intraperitoneal structures to the retroperitoneum.<\/jats:p><\/jats:sec>","DOI":"10.1007\/s00268-018-4792-6","type":"journal-article","created":{"date-parts":[[2018,9,17]],"date-time":"2018-09-17T16:19:11Z","timestamp":1537201151000},"page":"457-465","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["The Impact of Prior Laparotomy and Intra\u2010abdominal Adhesions on Bowel and Mesenteric Injury Following Blunt Abdominal Trauma"],"prefix":"10.1002","volume":"43","author":[{"given":"Tyler J.","family":"Loftus","sequence":"first","affiliation":[{"name":"Department of Surgery University of Florida Health 1600 SW Archer Road, Box 100108 32610 Gainesville FL USA"},{"name":"Sepsis and Critical Illness Research Center University of Florida Health Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Megan L.","family":"Morrow","sequence":"additional","affiliation":[{"name":"Department of Surgery Florida Atlantic University Boca Raton FL USA"},{"name":"Department of Surgery St. Mary\u2019s Medical Center West Palm Beach FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lawrence","family":"Lottenberg","sequence":"additional","affiliation":[{"name":"Department of Surgery Florida Atlantic University Boca Raton FL USA"},{"name":"Department of Surgery St. Mary\u2019s Medical Center West Palm Beach FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin D.","family":"Rosenthal","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Florida Health 1600 SW Archer Road, Box 100108 32610 Gainesville FL USA"},{"name":"Sepsis and Critical Illness Research Center University of Florida Health Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chasen A.","family":"Croft","sequence":"additional","affiliation":[{"name":"Department of Surgery University of Florida Health 1600 SW Archer Road, Box 100108 32610 Gainesville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"R. 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