'Car-crusher colon'

Traumatic 'degloving' of the colon in blunt abdominal injury

We describe two cases of traumatic 'degloving' of the colon in blunt abdominal trauma. This is an extremely rare injury with the potential to present late. The mechanism of injury appears to be a combination of focal blunt abdominal trauma associated with a shearing force. The potential diagnostic dilemma posed by colonic 'degloving' is outlined and following review of the literature we conclude that CT scanning is the most reliable way of detecting such injuries, if emergency laparotomy is not indicated.

Traumatic seromuscular rupture of intestine: the acute and chronic forms

BACKGROUND

Traumatic seromuscular rupture of intestine in the acute form is recognized by surgeons and pathologists and has received mention in the medical literature. The authors encountered two cases of this lesion presenting in the chronic form, in one case initially going unrecognized, both in battered children. To our knowledge, the chronic form of the injury has not been previously described in the literature. Three lesions in the acute stage were used to analyze the evolutionary stages of the chronic presentation.

METHODS

The two chronic cases are described, together with gross and microscopic photographs. Three acute lesions are also described, with illustrations, two in battered children and one in a pedestrian/vehicle fatality.

RESULTS

The three acute cases illustrate the pathogenesis and gradation of the injury that, in the absence of surgical therapy, will develop into the chronic lesion. The two chronic case descriptions illustrate the gross and microscopic pathology and the pathognomonic features.

CONCLUSION

Seromuscular rupture of the intestine, when left untreated, develops in time into a lesion that may appear cryptogenic to the surgeon or the pathologist. This paper defines that lesion and its pathogenesis.

The influence of personal blast protection on the distribution and severity of primary blast gut injury

Primary blast injuries have been recognized since World War I when the most significant reported injury was to the lung. The prevalence of injury to tissues containing air was underlined by the frequency of gut blast injury in underwater explosions mostly reported during World War II. Gut injury is the most likely cause of mortality after the more immediate effects of pulmonary primary blast injury. Effective protection has been achieved for lungs exposed to short duration external blast waves by the placement of stress wave decouplers on to the thoracoabdominal wall in a pig model, thus modifying the energy coupled into the body. A combination of two densities of glass-reinforced plastic plate and Plastazote foam (GRP/PZ) effectively eliminated pulmonary injury in 17 protected animals, compared with the production of severe blast lung in nine unprotected animals (p < 0.001). Partial pulmonary protection was achieved using a plasticized lead and plastazote foam decoupling combination (PbPVC/PZ) in a further group of 10 animals. Peak incident overpressures were not significantly different in any group. Small bowel contusions were highly significantly reduced in the GRP/PZ groups when compared with unprotected animals and with PbPVC protected animals (both p < 0.001); no significant reduction was observed in the summed colonic contusion size in any protected group. Intestinal perforations were also highly significantly reduced in both GRP/PZ groups (p < 0.001). Primary pulmonary blast injury and probably small bowel injury are caused by the propagation of coupled stress waves within the body. Elimination of these injuries implies prevention of stress wave propagation. Because colonic injury was not prevented by the same protection, a different mechanism for the injury is suggested: transmission and propagation of shear waves. These findings have important implications for blast protection and the clinical management of primary blast casualties.