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Dilday J, Owattanapanich N, Benjamin ER, Biswas S, Shackelford S, Demetriades D. Injury Patterns and Treatment Strategies in Civilian and Military Isolated Abdominal Gunshot Wounds. World J Surg 2023; 47:2635-2643. [PMID: 37530783 DOI: 10.1007/s00268-023-07132-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Combat-related gunshot wounds (GSW) may differ from those found in civilian trauma centers. Missile velocity, resources, logistics, and body armor may affect injury patterns and management strategies. This study compares injury patterns, management, and outcomes in isolated abdominal GSW between military (MIL) and civilian (CIV) populations. METHODS The Department of Defense Trauma Registry (DoDTR) and TQIP databases were queried for patients with isolated abdominal GSW from 2013 to 2016. MIL patients were propensity score matched 1:3 based on age, sex, and extraabdominal AIS. Injury patterns and in-hospital outcomes were compared. Initial operative management strategies, including selective nonoperative management (SNOM) for isolated solid organ injuries, were also compared. RESULTS Of the 6435 patients with isolated abdominal GSW, 183 (3%) MIL were identified and matched with 549 CIV patients. The MIL group had more hollow viscus injuries (84% vs. 66%) while the CIV group had more vascular injuries (10% vs. 21%) (p < .05 for both). Operative strategy differed, with more MIL patients undergoing exploratory laparotomy (95% vs. 82%) and colectomy (72% vs. 52%) (p < .05 for both). However, no difference in ostomy creation was appreciated. More SNOM for isolated solid organ injuries was performed in the CIV group (34.1% vs. 12.5%; p < 0.05). In-hospital outcomes, including mortality, were similar between groups. CONCLUSIONS MIL abdominal GSW lead to higher rates of hollow viscus injuries compared to CIV GSW. MIL GSW are more frequently treated with resection but with similar ostomy creation compared to civilian GSW. SNOM of solid organ injuries is infrequently performed following MIL GSW.
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Affiliation(s)
- Joshua Dilday
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA
| | - Natthida Owattanapanich
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA
| | - Elizabeth R Benjamin
- Division of Trauma and Surgical Critical Care, Emory University, Grady Health System, Atlanta, GA, USA
| | - Subarna Biswas
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA
| | | | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, Los Angeles General Medical Center, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA.
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Bozzay JD, Walker PF, Schechtman DW, Shaikh F, Stewart L, Carson ML, Tribble DR, Rodriguez CJ, Bradley MJ. Risk factors for abdominal surgical site infection after exploratory laparotomy among combat casualties. J Trauma Acute Care Surg 2021; 91:S247-S255. [PMID: 33605707 PMCID: PMC8324514 DOI: 10.1097/ta.0000000000003109] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Surgical site infections (SSIs) are well-recognized complications after exploratory laparotomy for abdominal trauma; however, little is known about SSI development after exploration for battlefield abdominal trauma. We examined SSI risk factors after exploratory laparotomy among combat casualties. METHODS Military personnel with combat injuries sustained in Iraq and Afghanistan (June 2009 to May 2014) who underwent laparotomy and were evacuated to participating US military hospitals were included. Log-binominal regression was used to identify SSI risk factors. RESULTS Of 4,304 combat casualties, 341 patients underwent a total of 1,053 laparotomies. Abdominal SSIs were diagnosed in 49 patients (14.4%): 8% with organ space SSI, 4% with deep incisional SSI, and 4% with superficial SSIs (4 patients had multiple SSIs). Patients with SSIs had more colorectal (p < 0.001), small bowel (p = 0.010), duodenum (p = 0.006), pancreas (p = 0.032), and abdominal vascular injuries (p = 0.040), as well as prolonged open abdomen (p = 0.004) and more infections diagnosed before the SSI (or final exploratory laparotomy) versus non-SSI patients (p < 0.001). Sustaining colorectal injuries (risk ratio [RR], 3.20; 95% confidence interval [CI], 1.58-6.45), duodenum injuries (RR, 6.71; 95% CI, 1.73-25.58), and being diagnosed with prior infections (RR, 10.34; 95% CI, 5.05-21.10) were independently associated with any SSI development. For either organ space or deep incisional SSIs, non-intra-abdominal infections, fecal diversion, and duodenum injuries were independently associated, while being injured via an improvised explosive device was associated with reduced likelihood compared with penetrating nonblast (e.g., gunshot wounds) injuries. Non-intra-abdominal infections and hypotension were independently associated with organ space SSIs development alone, while sustaining blast injuries were associated with reduced likelihood. CONCLUSION Despite severity of injuries and the battlefield environment, the combat casualty laparotomy SSI rate is relatively low at 14%, with similar risk factors and rates reported following severe civilian trauma. LEVEL OF EVIDENCE Epidemiological, level III.
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Affiliation(s)
- Joseph D Bozzay
- From the Department of Surgery, Uniformed Services University of the Health Sciences, Walter Reed National Military Medical Center (J.D.B., P.F.W., M.J.B.), Bethesda, Maryland; Brooke Army Medical Center (D.W.S.), JBSA Fort Sam Houston, Texas; Infectious Disease Clinical Research Program, Department of Preventive Medicine and Biostatistics (D.R.T.), Uniformed Services University of the Health Sciences, Bethesda, Maryland; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc. (F.S., L.S., M.L.C.), Bethesda, Maryland; John Peter Smith Hospital (C.J.R.), Fort Worth, Texas, Bethesda, Maryland
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McKnight GHO, Yalamanchili S, Sanchez-Thompson N, Guidozzi N, Dunhill-Turner N, Holborow A, Batrick N, Hettiaratchy S, Khan M, Kashef E, Aylwin C, Frith D. Penetrating gluteal injuries in North West London: a retrospective cohort study and initial management guideline. Trauma Surg Acute Care Open 2021; 6:e000727. [PMID: 34395917 PMCID: PMC8311336 DOI: 10.1136/tsaco-2021-000727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 06/22/2021] [Indexed: 11/10/2022] Open
Abstract
Background Penetrating gluteal injuries (PGIs) are an increasingly common presentation to major trauma centers (MTCs) in the UK and especially in London. PGIs can be associated with mortality and significant morbidity. There is a paucity of consistent guidance on how best to investigate and manage these patients. Methods A retrospective cohort study was performed by interrogating prospectively collected patient records for PGI presenting to a level 1 MTC in London between 2017 and 2019. Results There were 125 presentations with PGI, accounting for 6.86% of all penetrating injuries. Of these, 95.2% (119) were male, with a median age of 21 (IQR 18–29), and 20.80% (26) were under 18. Compared with the 3 years prior to this study, the number of PGI increased by 87%. The absolute risk (AR) of injury to a significant structure was 27.20%; the most frequently injured structure was a blood vessel (17.60%), followed by the rectum (4.80%) and the urethra (1.60%). The AR by anatomic quadrant of injury was highest in the lower inner quadrant (56%) and lowest in the upper outer quadrant (14%). CT scanning had an overall sensitivity of 50% and specificity of 92.38% in identifying rectal injury. Discussion The anatomic quadrant of injury can be helpful in stratifying risk of rectal and urethral injuries when assessing a patient in the emergency department. Given the low sensitivity in identifying rectal injury on initial CT, this data supports assesing any patients considered at high risk of rectal injury with an examination under general anesthetic with or without rigid sigmoidoscopy. The pathway has created a clear tool that optimizes investigation and treatment, minimizing the likelihood of missed injury or unnecessary use of resources. It therefore represents a potential pathway other centers receiving a similar trauma burden could consider adopting. Level of evidence 2b.
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Affiliation(s)
- Gerard Hywel Owen McKnight
- Institute of Naval Medicine, Royal Navy, Gosport, UK.,Major Trauma, Imperial College Healthcare NHS Trust, London, UK
| | - Seema Yalamanchili
- Major Trauma, Imperial College Healthcare NHS Trust, London, UK.,Division of Surgery and Cancer, Imperial College London Faculty of Medicine, London, UK
| | | | - Nadia Guidozzi
- Major Trauma, Imperial College Healthcare NHS Trust, London, UK
| | | | - Alex Holborow
- Department of Radiology, Swansea Bay University Health Board, Swansea, UK
| | - Nicola Batrick
- Major Trauma, Imperial College Healthcare NHS Trust, London, UK
| | | | - Mansoor Khan
- Major Trauma, Imperial College Healthcare NHS Trust, London, UK
| | - Elika Kashef
- Major Trauma, Imperial College Healthcare NHS Trust, London, UK
| | - Chris Aylwin
- Major Trauma, Imperial College Healthcare NHS Trust, London, UK
| | - Dan Frith
- Major Trauma, Imperial College Healthcare NHS Trust, London, UK
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Saldarriaga LG, Palacios-Rodríguez HE, Pino LF, Hadad AG, Capre J, García A, Rodríguez-Holguín F, Salcedo A, Serna JJ, Herrera MA, Parra MW, Ordoñez CA, Kestenberg-Himelfarb A. Rectal damage control: when to do and not to do. Colomb Med (Cali) 2021; 52:e4124776. [PMID: 34188328 PMCID: PMC8216057 DOI: 10.25100/cm.v52i2.4776] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 04/21/2021] [Accepted: 05/13/2021] [Indexed: 11/11/2022] Open
Abstract
Rectal trauma is uncommon, but it is usually associated with injuries in adjacent pelvic or abdominal organs. Recent studies have changed the paradigm behind military rectal trauma management, showing better morbidity and mortality. However, damage control techniques in rectal trauma remain controversial. This article aims to present an algorithm for the treatment of rectal trauma in a patient with hemodynamic instability, according to damage control surgery principles. We propose to manage intraperitoneal rectal injuries in the same way as colon injuries. The treatment of extraperitoneal rectum injuries will depend on the percentage of the circumference involved. For injuries involving more than 25% of the circumference, a colostomy is indicated. While injuries involving less than 25% of the circumference can be managed through a conservative approach or primary repair. In rectal trauma, knowing when to do or not to do it makes the difference.
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Affiliation(s)
- Luis Guillermo Saldarriaga
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Helmer Emilio Palacios-Rodríguez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Adolfo González Hadad
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Centro Médico Imbanaco, Cali, Colombia
| | - Jessica Capre
- Fundación Valle del Lili, Department of Surgery, Division of Colorectal Surgery , Cali, Colombia
| | - Alberto García
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | | | - Alexander Salcedo
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Colorectal Surgery , Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - José Julián Serna
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Michael W. Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL, USA
| | - Carlos A. Ordoñez
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
- Universidad Icesi, Cali, Colombia
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Skube ME, Mallery Q, Lusczek E, Elterman J, Spott MA, Beilman GJ. Characteristics of Combat-Associated Small Bowel Injuries. Mil Med 2018; 183:e454-e459. [PMID: 29546406 PMCID: PMC6136988 DOI: 10.1093/milmed/usy009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 11/27/2017] [Accepted: 01/18/2018] [Indexed: 01/04/2023] Open
Abstract
INTRODUCTION Although there are multiple studies regarding the management and outcomes of colonic injuries incurred in combat, the literature is limited with regard to small bowel injuries. This study seeks to provide the largest reported review of the characteristics of combat-associated small bowel injuries. MATERIALS AND METHODS The Department of Defense Trauma Registry was queried for U.S. Armed Forces members who sustained hollow viscus injuries in the years 2007-2012 during Operations Enduring Freedom, Iraqi Freedom, and New Dawn. Concomitant injuries, procedures, and complications were delineated. Fisher's exact test was used to analyze the relationship of bowel injury pattern to rates of repeat laparotomy, fecal diversion, and complications. RESULTS One hundred seventy-one service members had small bowel injuries. The mean age was 25.8 ± 6.6 yr with a mean injury severity score of 27.9 ± 12.4. The majority of injuries were penetrating (94.2%, n = 161) as a result of explosive devices (61.4%, n = 105). The median blood transfusion requirement in the first 24 h was 6.0 units (interquartile range 1.0-17.3 units). The most frequent concomitant injuries were large bowel (64.3%, n = 110), pelvic fracture (35.7%, n = 61), and perineal (26.3%, n = 45). Fifty patients (29.2%) had a colostomy, and nine patients (5.3%) had an ileostomy; 62.6% (n = 107) of soldiers underwent more than one laparotomy. The mortality rate was 1.8% (n = 3). The most common complications were pneumonia (15.2%, n = 26), deep vein thrombosis (14.6%, n = 25), and wound infection (14.6%, n = 25). The need for repeat laparotomy and fecal diversion was found to be significantly associated with injury pattern (p = 0.00052 and p < 0.0001, respectively). CONCLUSION We found that two-thirds of service members with small bowel injuries also had a large bowel injury. One-third of the patients required diversion and two-thirds had more than one laparotomy. The pattern of bowel injury significantly affected the need for repeat laparotomy and fecal diversion.
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Affiliation(s)
- Mariya E Skube
- Department of Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, MN
| | - Quinn Mallery
- Department of Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, MN
| | - Elizabeth Lusczek
- Department of Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, MN
| | - Joel Elterman
- Department of Surgery, University of Cincinnati, 231 Albert Sabin Way, Cincinnati, OH
| | - Mary A Spott
- U.S. Army Institute of Surgical Research, 3698 Chambers Pass Ste B, JBSA Ft Sam Houston, TX
| | - Greg J Beilman
- Department of Surgery, University of Minnesota, 420 Delaware St SE, Minneapolis, MN
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Johnston LR, Bradley MJ, Rodriguez CJ, McNally MP, Elster EA, Duncan JE. Assessing Risk and Related Complications after Reversal of Combat-Associated Ostomies. J Am Coll Surg 2018; 227:367-373. [PMID: 29906614 DOI: 10.1016/j.jamcollsurg.2018.05.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 05/29/2018] [Accepted: 05/29/2018] [Indexed: 11/15/2022]
Abstract
BACKGROUND During the past decade of conflict, numerous patients with combat-associated injuries required the formation of an ostomy. However, outcomes in those patients undergoing ostomy reversal have yet to be analyzed. We review the experience and identify risk factors for complications after ostomy reversal in a series of patients with combat injuries at our military treatment facility. STUDY DESIGN A retrospective review of patients with combat-associated injuries managed with a diverting ostomy who underwent ostomy reversal at our military treatment facility during a 13-year period. Demographic and clinical data were collected for all patients and postoperative complications were identified. Multivariate analysis was performed to identify independent risk factors for complications after reversal. Complication rates were calculated for 90-day periods of time after ostomy creation and best-fit curve analysis was conducted. RESULTS Ninety-nine patients were identified who underwent ostomy reversal. Forty patients (40.4%) suffered a post-reversal complication. On multivariate analysis, older age (odds ratio 1.11/y; p = 0.038), severe perineal injury indication for diversion (odds ratio 4.37; p = 0.028), and increased time interval between ostomy creation and reversal (odds ratio 1.005/d; p = 0.037), were independently associated with postoperative complications. A cubic regression best fit quarterly complication rate data (R2 0.526; p < 0.001) and calculates a minimum complication rate for reversal 90 to 180 days after ostomy creation. CONCLUSIONS Ostomy reversal in patients wounded in combat is a major undertaking with a high complication rate. The finding of a shorter interval from ostomy creation to reversal independently associated with a reduction in complications provides a modifiable risk factor to guide future practice and potentially reduce complications. Our modeling suggests reversal in the 3- to 6-month time frame can have the lowest rate of complications. Future research to reduce complications is indicated, especially in older patients with perineal wounds.
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Affiliation(s)
- Luke R Johnston
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, MD.
| | - Matthew J Bradley
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, MD; Surgical Critical Care Initiative, Uniformed Services University, Bethesda, MD; Department of Regenerative Medicine, Naval Medical Research Center, Silver Spring, MD
| | - Carlos J Rodriguez
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, MD
| | - Michael P McNally
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, MD
| | - Eric A Elster
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, MD; Surgical Critical Care Initiative, Uniformed Services University, Bethesda, MD
| | - James E Duncan
- Department of Surgery, Uniformed Services University of the Health Sciences-Walter Reed National Military Medical Center, Bethesda, MD
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Abstract
The management of rectal trauma has often been lumped in with colon trauma when, in fact, it is a unique entity. The anatomic nature of the rectum (with its intra- and extraperitoneal segments) lends itself to unique circumstances when it comes to management and treatment. From the four Ds (debridement, drainage, diversion, and distal irrigation), the management of rectal trauma has made some strides in light of the experiences coming out of the recent conflicts overseas as well as some rethinking of dogma. This article will serve to review the anatomy and types of injuries associated with rectal trauma. A treatment algorithm will also be presented based on our current literature review. We will also address controversial points and attempt to give our opinion in an effort to provide an update on an age-old problem.
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Affiliation(s)
- Michael S Clemens
- Division of Colon and Rectal Surgery, San Antonio Military Medical Center, Sam Houston, Texas
| | - Kaitlin M Peace
- Division of Colon and Rectal Surgery, San Antonio Military Medical Center, Sam Houston, Texas
| | - Fia Yi
- Division of Colon and Rectal Surgery, San Antonio Military Medical Center, Sam Houston, Texas
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Choi PM, Wallendorf M, Keller MS, Vogel AM. Traumatic colorectal injuries in children: The National Trauma Database experience. J Pediatr Surg 2017; 52:1625-1627. [PMID: 28366562 DOI: 10.1016/j.jpedsurg.2017.03.055] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Revised: 02/28/2017] [Accepted: 03/22/2017] [Indexed: 12/15/2022]
Abstract
PURPOSE We sought to utilize a nationwide database to characterize colorectal injuries in pediatric trauma. METHODS The National Trauma Database (NTDB) was queried for all patients (age≤14years) with colorectal injuries from 2013 to 2014. We stratified patients by demographics and measured outcomes. We analyzed groups based on mechanism, colon vs rectal injury, as well as colostomy creation. Statistical analysis was conducted using t-test and ANOVA for continuous variables as well as chi-square for continuous variables. RESULTS There were 534 pediatric patients who sustained colorectal trauma. The mean ISS was 15.6±0.6 with an average LOS of 8.5±0.5days. 435 (81.5%) were injured by blunt mechanism while 99 (18.5%) were injured by penetrating mechanism. There were no differences between age, ISS, complications, mortality, LOS, ICU LOS, and ventilator days between blunt and penetrating groups. Significantly more patients in the penetrating group had associated small intestine and hepatic injuries as well as underwent colostomies. Patients with rectal injuries (25.7%) were more likely to undergo colonic diversion (p<0.0001), but also had decreased mortality (p=0.001) and decreased LOS (p=0.01). Patients with colostomies (9.9%) had no differences in age, ISS, GCS, transfusion of blood products, and complications compared to patients who did not receive a colostomy. Despite this, colostomy patients had significantly increased hospital LOS (12.1±1.8 vs 8.2±0.5days, p=0.02) and ICU LOS (9.0±1.7 vs 5.4±0.3days, p=0.02). CONCLUSION Although infrequent, colorectal injuries in children are associated with considerable morbidity regardless of mechanism and may be managed without fecal diversion. LEVEL OF EVIDENCE III. STUDY TYPE Epidemiology.
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Affiliation(s)
- Pamela M Choi
- Division of Pediatric Surgery, Washington University School of Medicine in Saint Louis, One Children's Place, Saint Louis, MO 63110.
| | - Michael Wallendorf
- Division of Pediatric Surgery, Washington University School of Medicine in Saint Louis, One Children's Place, Saint Louis, MO 63110.
| | - Martin S Keller
- Division of Pediatric Surgery, Washington University School of Medicine in Saint Louis, One Children's Place, Saint Louis, MO 63110.
| | - Adam M Vogel
- Division of Pediatric Surgery, Texas Children's Hospital, 66701 Fannin Street, Houston, TX 77030.
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Lorenzo A, Pham H, Zahid A, Nguyen B, Pathmanathan N, Ctercteko G, Hsu JM. Traumatic colonic injuries in Westmead Hospital – A paradigm shift in management over 10 years. TRAUMA-ENGLAND 2017. [DOI: 10.1177/1460408616684865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Over the years, there has been a shift towards more conservative treatment, with primary repair of colonic injuries being preferred over faecal diversion. We present a cohort study of the management of penetrating colon injury over the past 10 years from a major trauma hospital in western Sydney. We aim to evaluate the trend of operative management of penetrating colonic injuries. Methods Patients were identified via the prospectively collected trauma registry at Westmead Hospital from 2003 to 2013. Fifty-seven patients initially identified with a proven diagnosis of penetrating colonic injury had their medical records reviewed. Excluded in the study are patients who had rectal injuries or serosal tears of the colon. Patient characteristics, mechanisms of injury, treatment course and complications were analysed. Extent of colonic injury was graded of using American Association for the Surgery of Trauma scalings. Results A total of 55 patients were then included in the study. Primary repair of colon injuries was the most common method used (63.6%, n = 35) followed by resection and primary anastomosis (21.8% n = 12), diverting colostomy (14.3%, n = 5) and non-operative management (5.5%, n = 3). There was a higher rate of diversion in the earlier time period (2003–2007) when compared to the later time period (2008–2013), p = 0.03. Over the 10-year period, there was no significant difference with regards to complications among groups, particularly intra-abdominal complications. Conclusion From 2003 to 2013, there is a shift of management of penetrating colonic injuries from diversion to resection and primary anastomosis to that of primary repair. Primary repair of colonic injuries is a safe option and is associated with low morbidity. It should be considered as a valid tool in the armamentarium of today’s surgeon.
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Affiliation(s)
- Aldenb Lorenzo
- Department of Colorectal Surgery, Westmead Hospital, Westmead, Australia
| | - Helen Pham
- Department of Colorectal Surgery, Westmead Hospital, Westmead, Australia
| | - Assad Zahid
- Department of Colorectal Surgery, Westmead Hospital, Westmead, Australia
| | - Ba Nguyen
- Department of Colorectal Surgery, Westmead Hospital, Westmead, Australia
| | | | - Graeme Ctercteko
- Department of Colorectal Surgery, Westmead Hospital, Westmead, Australia
| | - Jeremy M Hsu
- Trauma service Department, Westmead Hospital, Westmead, Australia
- Discipline of surgery, University of Sydney, Sydney, Australia
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Shazi B, Bruce JL, Laing GL, Sartorius B, Clarke DL. The management of colonic trauma in the damage control era. Ann R Coll Surg Engl 2016; 99:76-81. [PMID: 27659359 DOI: 10.1308/rcsann.2016.0303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION The purpose of this study was to audit our current management of colonic trauma, and to review our experience of colonic trauma in patients who underwent initial damage control (DC) surgery. METHODS All patients treated for colonic trauma between January 2012 and December 2014 by the Pietermaritzburg Metropolitan Trauma Service were included in the study. Data reviewed included mechanism of injury, method of management (primary repair [PR], primary diversion [PD] or DC) and outcome (complications and mortality rate). Results A total of 128 patients sustained a colonic injury during the study period. Ninety-seven per cent of the injuries were due to penetrating trauma. Of these cases, 56% comprised stab wounds (SWs) and 44% were gunshot wounds (GSWs). Management was by PR in 99, PD in 20 and DC surgery in 9 cases. Among the 69 SW victims, 57 underwent PR, 9 had PD and 3 required a DC procedure. Of the 55 GSW cases, 40 were managed with PR, 9 with PD and 6 with DC surgery. In the PR group, there were 16 colonic complications (5 cases of breakdown and 11 of wound sepsis). Overall, nine patients (7%) died. CONCLUSIONS PR of colonic trauma is safe and should be used for the majority of such injuries. Persistent acidosis, however, should be considered a contraindication. In unstable patients with complex injuries, the optimal approach is to perform DC surgery. In this situation, formal diversion is contraindicated, and the injury should be controlled and dropped back into the abdomen at the primary operation. At the repeat operation, if the physiological insult has been reversed, then formal repair of the colonic injury is acceptable.
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Affiliation(s)
- B Shazi
- University of KwaZulu-Natal , South Africa
| | - J L Bruce
- University of KwaZulu-Natal , South Africa
| | - G L Laing
- University of KwaZulu-Natal , South Africa
| | | | - D L Clarke
- University of KwaZulu-Natal , South Africa
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Ay N, Alp V, Aliosmanoğlu İ, Sevük U, Kaya Ş, Dinç B. Factors affecting morbidity and mortality in traumatic colorectal injuries and reliability and validity of trauma scoring systems. World J Emerg Surg 2015; 10:21. [PMID: 26023317 PMCID: PMC4446804 DOI: 10.1186/s13017-015-0014-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2014] [Accepted: 04/30/2015] [Indexed: 12/26/2022] Open
Abstract
Background and aim This study aims to determine the factors that affect morbidity and mortality in colon and rectum injuries related with trauma, the use of trauma scoring systems in predicting mortality and morbidity. Patients and methods Besides patient demographic characteristics, the mechanism of injury, the time between injury and surgery, accompanying body injuries, admittance Glasgow coma scale (GCS), findings at surgery and treatment methods were also recorded. With the obtained data, the abbreviated injury scale (AIS), injury severity score (ISS), revised trauma score (RTS) and trauma-ISS (TRISS) scores of each patient were calculated by using the 2008 revised AIS. Results Of the patients, 172 (88.7 %) were male, 22 (11.3 %) were female and the mean age was 29.15 ± 12.392 (15–89) years. The morbidity of our patients were 32 % and mortality were 12.4 %. ISS (p < 0.001), RTS (p < 0.001), and the TRISS (p < 0.001) on mortality were found to be significant. TRISS (p = 0.008), the ISS (p < 0.001), the RTS (p = 0.03), the trauma surgery interval (TSI, p < 0.001) were observed to have significant effects on morbidity. Regression analysis showed that the ISS (OR 1.1; CI 95 % 1.01–1.2; p = 0.02), the RTS (OR 0.37; CI 95 % 0.21–0.67; p = 0.001) had significant effects on mortality. While the effects of TSI (OR 5.3; CI 95 % 1.5–18.8; p = 0.01) on morbidity were found to be significant. Conclusion Predicting mortality by using scoring systems and close postoperative follow up of patients in the risk group may ensure decreases in the rates of morbidity and mortality.
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Affiliation(s)
- Nurettin Ay
- Diyarbakır Gazi Yaşargil Education and Research Hospital, Transplantation Center, Diyarbakır, Turkey
| | - Vahhaç Alp
- Department of General Surgery, Diyarbakir Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | | | - Utkan Sevük
- Department of Cardiovascular Surgery, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
| | - Şafak Kaya
- Department of İnfectious Disease, Diyarbakır Gazi Yaşargil Education and Research Hospital, Diyarbakır, Turkey
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A Prospective Observational Study of Abdominal Injury Management in Contemporary Military Operations. Ann Surg 2015; 261:765-73. [DOI: 10.1097/sla.0000000000000657] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Bingham JR, Steele SR. Influence of trauma, peritonitis, and obstruction on restoring intestinal continuity—To connect or not to connect? SEMINARS IN COLON AND RECTAL SURGERY 2014. [DOI: 10.1053/j.scrs.2014.04.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Watson JDB, Aden JK, Engel JE, Rasmussen TE, Glasgow SC. Risk factors for colostomy in military colorectal trauma: A review of 867 patients. Surgery 2014; 155:1052-61. [DOI: 10.1016/j.surg.2014.01.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 01/31/2014] [Indexed: 10/25/2022]
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Causey MW, Rivadeneira DE, Steele SR. Historical and current trends in colon trauma. Clin Colon Rectal Surg 2013; 25:189-99. [PMID: 24294119 DOI: 10.1055/s-0032-1329389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
The authors discuss the evolution of the evaluation and management of colonic trauma, as well as the debate regarding primary repair versus fecal diversion. Their evidence-based review covers diagnosis, management, surgical approaches, and perioperative care of patients with colon-related trauma. The management of traumatic colon injuries has evolved significantly over the past 50 years; here the authors describe a practical approach to the treatment and management of traumatic injuries to the colon based on the most current research. However, management of traumatic colon injuries remains a challenge and continues to be associated with significant morbidity. Familiarity with the different methods to the approach and management of colonic injuries will allow surgeons to minimize unnecessary complications and mortality.
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Affiliation(s)
- Marlin Wayne Causey
- Department of Surgery, Uniformed Services University of the Health Sciences (USUHS), Madigan Healthcare System, Fort Lewis, Washington
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Johnson EK, Steele SR. Evidence-based management of colorectal trauma. J Gastrointest Surg 2013; 17:1712-9. [PMID: 23824840 DOI: 10.1007/s11605-013-2271-9] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/17/2013] [Indexed: 01/31/2023]
Affiliation(s)
- Eric K Johnson
- Department of Surgery/Colorectal Surgery, Madigan Army Medical Center, Joint Base Lewis-McChord, Tacoma, WA 98431, USA.
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17
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Epidemiology of modern battlefield colorectal trauma: a review of 977 coalition casualties. J Trauma Acute Care Surg 2013. [PMID: 23192077 DOI: 10.1097/ta.0b013e3182754759] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Traumatic injuries to the lower gastrointestinal tract occur in up to 15% of all injured combatants, with significant morbidity (up to 75%) and mortality. The incidence, etiology, associated injuries, and overall mortality related to modern battlefield colorectal trauma are poorly characterized. METHODS Using data from the Joint Theater Trauma Registry and other Department of Defense electronic health records, the ongoing Joint Surgical Transcolonic Injury or Ostomy Multi-theater Assessment project quantifies epidemiologic trends in colon injury, risk factors for prolonged or perhaps unnecessary fecal diversion, and quality of life in US military personnel requiring colostomies. In the current study, all coalition troops with colon or rectal injuries as classified by DRG International Classification of Diseases-9th Rev. diagnosis and Abbreviated Injury Scale (AIS) codes in the Joint Theater Trauma Registry were included. RESULTS During 8 years, 977 coalition military personnel with colorectal injury were identified, with a mean (SD) Injury Severity Score (ISS) of 22.2 (13.2). Gunshot wounds remain the primary mechanism of injury (57.6%). Compared with personnel with colon injuries, those with rectal trauma sustained greater injury to face and extremities but fewer severe thoracic and abdominal injuries (p < 0.005). Overall fecal diversion rates were significantly higher in Iraq than in Afghanistan (38.7% vs. 31.6%, respectively; p = 0.03), predominantly owing to greater use of diversion for colon trauma. There was little difference in diversion rates between theaters for rectal injuries (59.6% vs. 50%, p < 0.15). The overall mortality rate was 8.2%. Notably, the mortality rate for patients with no fecal diversion (10.8%) was significantly greater than those with fecal diversion (3.7%, p < 0.0001). CONCLUSION Military personnel sustaining colon or rectal trauma continue to have elevated mortality rates, even after reaching surgical treatment facilities. Furthermore, associated serious injuries are commonly encountered. Fecal diversion in these patients may lead to reduced mortality, although prospective selection criteria for diversion do not currently exist. Future research into risk factors for colostomy creation, timing of diversion in relation to damage-control laparotomy, and quality of life in veterans with stomas will produce useful insights and help guide therapy. LEVEL OF EVIDENCE Epidemiologic study, level III.
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Housden S. Blast injury: A case study. Int Emerg Nurs 2012; 20:173-8. [DOI: 10.1016/j.ienj.2011.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2011] [Revised: 09/05/2011] [Accepted: 09/06/2011] [Indexed: 11/29/2022]
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Adherence to a Simplified Management Algorithm Reduces Morbidity and Mortality after Penetrating Colon Injuries: A 15-Year Experience. J Am Coll Surg 2012; 214:591-7; discussion 597-8. [DOI: 10.1016/j.jamcollsurg.2011.12.029] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Accepted: 12/15/2011] [Indexed: 10/14/2022]
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Sambasivan CN, Underwood SJ, Kuehn RB, Cho SD, Kiraly LN, Hamilton GJ, Flaherty SF, Dorlac WC, Schreiber MA. Management and Outcomes of Traumatic Colon Injury in Civilian and Military Patients. Am Surg 2011. [DOI: 10.1177/000313481107701244] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Divergent injury patterns may indicate the need for differing strategies in combat and civilian trauma patients. This study aims to compare outcomes of colon injury management in these two populations. Parallel retrospective reviews were conducted comparing warfighters (n = 59) injured downrange and subsequently transferred to the United States with civilians (n = 30) treated at a United States Level I trauma center. Patient characteristics, mechanisms of injury, treatment course, and complications were compared. The civilian (CP) and military (MP) populations did not differ in Injury Severity Score (MP 20 vs CP 26; P = 0.41). The MP experienced primarily blast injuries (51%) as opposed to blunt trauma (70%; P < 0.01) in the CP. The site of colon injury did not differ between groups ( P = 0.15). Initial management was via primary repair (53%) and resection and anastomosis (27%) in the CP versus colostomy creation (47%) and stapled ends (32%) in the MP ( P < 0.001). Ultimately, the CP and MP experienced equivalent continuity rates (90%). Overall complications (MP 68% vs CP 53%; P = 0.18) and mortality (MP 3% vs CP 3%; P = 0.99) did not differ between the two groups. The CP and MP experience different mechanisms and initial management of colon injury. Ultimately, continuity is restored in the majority of both populations.
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Affiliation(s)
| | | | | | - S. D. Cho
- Oregon Health and Science University, Portland, Oregon
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Ordoñez CA, Pino LF, Badiel M, Sánchez AI, Loaiza J, Ballestas L, Puyana JC. Safety of performing a delayed anastomosis during damage control laparotomy in patients with destructive colon injuries. THE JOURNAL OF TRAUMA 2011; 71:1512-7; discussion 1517-8. [PMID: 22182861 PMCID: PMC3413258 DOI: 10.1097/ta.0b013e31823d0691] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent studies report the safety and feasibility of performing delayed anastomosis (DA) in patients undergoing damage control laparotomy (DCL) for destructive colon injuries (DCIs). Despite accumulating experience in both civilian and military trauma, questions regarding how to best identify high-risk patients and minimize the number of anastomosis-associated complications remain. Our current practice is to perform a definitive closure of the colon during DCL, unless there is persistent acidosis, bowel wall edema, or evidence of intra-abdominal abscess. In this study, we evaluated the safety of this approach by comparing outcomes of patients with DCI who underwent definitive closure of the colon during DCL versus patients managed with colostomy with or without DCL. METHODS We performed a retrospective chart review of patients with penetrating DCI during 2003 to 2009. Severity of injury, surgical management, and clinical outcome were assessed. RESULTS Sixty patients with severe gunshot wounds and three patients with stab wounds were included in the analysis. DCL was required in 30 patients, all with gunshot wounds. Three patients died within the first 48 hours, three underwent colostomy, and 24 were managed with DA. Thirty-three patients were managed with standard laparotomy: 26 patients with primary anastomosis and 7 with colostomy. Overall mortality rate was 9.5%. Three late deaths occurred in the DCL group, and only one death was associated with an anastomotic leak. CONCLUSIONS Performing a DA in DCI during DCL is a reliable and feasible approach as long as severe acidosis, bowel wall edema, and/or persistent intra-abdominal infections are not present.
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Affiliation(s)
- Carlos A Ordoñez
- Departamento de Cirugía, Fundación Valle del Lili, Cali, Colombia
- Unidad de Cuidado Intensivo, Fundación Valle del Lili, Cali, Colombia
- Departamento de Cirugía, Universidad del Valle, Cali, Colombia
| | - Luis F Pino
- Departamento de Cirugía, Fundación Valle del Lili, Cali, Colombia
- Unidad de Cuidado Intensivo, Fundación Valle del Lili, Cali, Colombia
- Departamento de Cirugía, Universidad del Valle, Cali, Colombia
| | - Marisol Badiel
- Instituto de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
| | - Alvaro I Sánchez
- Instituto CISALVA, Universidad del Valle, Cali, Colombia
- Department of Surgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Jhon Loaiza
- Instituto de Investigaciones Clínicas, Fundación Valle del Lili, Cali, Colombia
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Bowley DM, Jansen JO, Nott D, Sapsford W, Streets CG, Tai NRM. Difficult decisions in the surgical care of military casualties with major torso trauma. J ROY ARMY MED CORPS 2011; 157:S324-33. [PMID: 22049815 DOI: 10.1136/jramc-157-03s-12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Testing and difficult decision-making is a sine qua non of surgical practice on military operations. Better pre-hospital care protocols, reduced evacuation timelines and increased scrutiny of outcome have rightfully emphasised the requirement of surgeons to "get it right, first time and every time" when treating patients. This article addresses five contentious areas concerning severe torso trauma, with relevant literature summarised by a subject matter expert, in order to produce practical guidance that will assist the newly deployed surgeon in delivering optimal clinical outcomes.
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Affiliation(s)
- D M Bowley
- Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine
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Guidelines for the prevention of infections associated with combat-related injuries: 2011 update: endorsed by the Infectious Diseases Society of America and the Surgical Infection Society. ACTA ACUST UNITED AC 2011; 71:S210-34. [PMID: 21814089 DOI: 10.1097/ta.0b013e318227ac4b] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite advances in resuscitation and surgical management of combat wounds, infection remains a concerning and potentially preventable complication of combat-related injuries. Interventions currently used to prevent these infections have not been either clearly defined or subjected to rigorous clinical trials. Current infection prevention measures and wound management practices are derived from retrospective review of wartime experiences, from civilian trauma data, and from in vitro and animal data. This update to the guidelines published in 2008 incorporates evidence that has become available since 2007. These guidelines focus on care provided within hours to days of injury, chiefly within the combat zone, to those combat-injured patients with open wounds or burns. New in this update are a consolidation of antimicrobial agent recommendations to a backbone of high-dose cefazolin with or without metronidazole for most postinjury indications, and recommendations for redosing of antimicrobial agents, for use of negative pressure wound therapy, and for oxygen supplementation in flight.
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Prevention of infections associated with combat-related thoracic and abdominal cavity injuries. ACTA ACUST UNITED AC 2011; 71:S270-81. [PMID: 21814093 DOI: 10.1097/ta.0b013e318227adae] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Trauma-associated injuries of the thorax and abdomen account for the majority of combat trauma-associated deaths, and infectious complications are common in those who survive the initial injury. This review focuses on the initial surgical and medical management of torso injuries intended to diminish the occurrence of infection. The evidence for recommendations is drawn from published military and civilian data in case reports, clinical trials, meta-analyses, and previously published guidelines, in the interval since publication of the 2008 guidelines. The emphasis of these recommendations is on actions that can be taken in the forward-deployed setting within hours to days of injury. This evidence-based medicine review was produced to support the Guidelines for the Prevention of Infections Associated With Combat-Related Injuries: 2011 Update contained in this supplement of Journal of Trauma.
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Abstract
BACKGROUND The treatment of traumatic injuries to the colon and rectum is often driven by dogma, despite the presence of evidence suggesting alternative methods of care. OBJECTIVE This is an evidence-based review, in the format of a review article, to determine the ideal treatment of noniatrogenic traumatic injuries to the colon and rectum to improve the care provided to this group of patients. Recommendations and treatment algorithms were based on consensus conclusions of the data. DATA SOURCES A search of MEDLINE, PubMed, and the Cochrane Database of Collected Reviews was performed from 1965 through December 2010. STUDY SELECTION Authors independently reviewed selected abstracts to determine their scientific merit and relevance based on key-word combinations regarding colorectal trauma. A directed search of the embedded references from the primary articles was also performed in select circumstances. We then performed a complete evaluation of 108 articles and 3 additional abstracts. MAIN OUTCOME MEASURES The main outcomes were morbidity, mortality, and colostomy rates. RESULTS Evidence-based recommendations and algorithms are presented for the management of traumatic colorectal injuries. LIMITATIONS Level I and II evidence was limited. CONCLUSIONS Colorectal injuries remain a challenging clinical entity associated with significant morbidity. Familiarity with the different methods to approach and manage these injuries, including "damage control" tactics when necessary, will allow surgeons to minimize unnecessary complications and mortality.
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Affiliation(s)
- Scott R Steele
- USUHS, Department of Surgery, Madigan Army Medical Center, Ft Lewis, Washington, USA.
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Choi WJ. Management of colorectal trauma. JOURNAL OF THE KOREAN SOCIETY OF COLOPROCTOLOGY 2011; 27:166-72. [PMID: 21980586 PMCID: PMC3180596 DOI: 10.3393/jksc.2011.27.4.166] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2010] [Accepted: 11/25/2010] [Indexed: 12/01/2022]
Abstract
Although the treatment strategy for colorectal trauma has advanced during the last part of the twentieth century and the result has improved, compared to other injuries, problems, such as high septic complication rates and mortality rates, still exist, so standard management for colorectal trauma is still a controversial issue. For that reason, we designed this article to address current recommendations for management of colorectal injuries based on a review of literature. According to the reviewed data, although sufficient evidence exists for primary repair being the treatment of choice in most cases of nondestructive colon injuries, many surgeons are still concerned about anastomotic leakage or failure, and prefer to perform a diverting colostomy. Recently, some reports have shown that primary repair or resection and anastomosis, is better than a diverting colostomy even in cases of destructive colon injuries, but it has not fully established as the standard treatment. The same guideline as that for colonic injury is applied in cases of intraperitoneal rectal injuries, and, diversion, primary repair, and presacral drainage are regarded as the standards for the management of extraperitoneal rectal injuries. However, some reports state that primary repair without a diverting colostomy has benefit in the treatment of extraperitoneal rectal injury, and presacral drainage is still controversial. In conclusion, ideally an individual management strategy would be developed for each patient suffering from colorectal injury. To do this, an evidence-based treatment plan should be carefully developed.
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Affiliation(s)
- Won Jun Choi
- Department of Surgery, Konyang University College of Medicine, Daejeon, Korea
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