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primary closure of colon injuries in penetrating abdominal trauma

Lauren T Greer, Suzanne M Gillern, Amy E Vertrees
The colon is the second most commonly injured intra-abdominal organ in penetrating trauma. Management of traumatic colon injuries has evolved significantly over the past 200 years. Traumatic colon injuries can have a wide spectrum of severity, presentation, and management options. There is strong evidence that most non-destructive colon injuries can be successfully managed with primary repair or primary anastomosis. The management of destructive colon injuries remains controversial with most favoring resection with primary anastomosis and others favor colonic diversion in specific circumstances...
February 2013: American Surgeon
Carlos A Ordoñez, Luis F Pino, Marisol Badiel, Alvaro I Sánchez, Jhon Loaiza, Leonardo Ballestas, Juan Carlos Puyana
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...
December 2011: Journal of Trauma
Julie Menard, Gretchen L Schoeffler
OBJECTIVE: To report the surgical repair, case management, and outcome of a dog with sepsis and severe intraabdominal trauma secondary to a penetrating stick injury. CASE OR SERIES SUMMARY: A 1.5-year-old, spayed female, mixed-breed dog was presented to the emergency service after incurring a small laceration on the medial aspect of the left pelvic limb while running in the woods. The wound was surgically explored and a primary closure achieved. The patient was discharged the same day with oral antimicrobial therapy...
August 2011: Journal of Veterinary Emergency and Critical Care
Luis Enrique Salinas-Aragón, Lorenzo Guevara-Torres, Enrique Vaca-Pérez, Jaime Arístides Belmares-Taboada, Fátima de Guadalupe Ortiz-Castillo, Martín Sánchez-Aguilar
BACKGROUND: Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality...
September 2009: Cirugia y Cirujanos
Adedoyin A Adesanya, Ekanem E Ekanem
BACKGROUND: Colon injury has been associated with a high risk of septic complications and mortality. We prospectively studied the pattern, management, outcome, and prognostic factors in patients who sustained penetrating colon injuries. PATIENTS AND METHODS: Sixty patients who presented to our hospital with penetrating colon injuries over a ten-year period (1992 to 2001) were studied. RESULTS: Colon wounds were caused by gunshots in 55 (91...
December 2004: Diseases of the Colon and Rectum
C Chanson, K Nassiopoulos, P Kiesler, P Petropoulos
There is nowadays no current randomised study able to answer if a diverting colostomy is necessary or not in the surgical management of civilian colon trauma. We report our experience on 13 cases treated during the period from 1977 to 1997. There were 3 stab wounds, 4 gunshot traumas and 6 perforations of the colon caused by blunt mechanisms. Four patients underwent a primary colonic closure and 9 others a primary resection with anastomosis. In none of all our cases a diverting colostomy was performed. We experienced a fatal complication once and this was due to an underestimated segmental ischemia of the colon after blunt injury...
1998: Swiss Surgery, Schweizer Chirurgie, Chirurgie Suisse, Chirurgia Svizzera
S R Thomson, A Baker, L W Baker
Solitary colon injuries are being increasingly managed by intraperitoneal primary closure. The optimal management of the colon wound in multiple injuries of the colon, which have a high mortality, has not been determined. From 1983-1989, 668 patients sustained colonic injuries. In 71 of these patients the colon was injured at more than one site. Of the 597 single injuries to the colon, 472 (79%) were due to stabs and 102 (17%) to gunshot wounds. Sixty-eight men and three women sustained injuries at more than one site in the large intestine...
February 1996: Journal of the Royal College of Surgeons of Edinburgh
J Civera Muñoz, R Palasi Giménez, S Gómez Iglesias, F Carbonell Tatay, J Del Pino Porres, E Cepeda Callejo, S Sancho-Fornos
OBJECTIVE: This is a retrospective study to evaluate our results in the treatment of abdominal trauma. DESIGN: We have analysed the incidence, the clinical characteristics, the diagnosis, the indications for laparotomy, the therapeutic methods and the morbidity-mortality. During the last 14 years we have operated on 29 hollow viscus injuries. They were divided into two groups: Eleven with penetrating or open trauma and 18 with blunt or closed traumatism. RESULTS: In the cases of blunt trauma 36...
November 1995: Revista Española de Enfermedades Digestivas
P A Taheri, J J Ferrara, C E Johnson, K A Lamberson, L M Flint
Over the past 14 years, 146 patients with penetrating colon trauma were managed by primary repair with/without resection (PR, n = 55), and by diverting colostomy (DC, n = 91). These groups did not differ in terms of age, ISS (Injury Severity Scale), PATI (Penetrating Abdominal Trauma Index), a-AIS (abdominal Abbreviated Injury Scale), or preoperative hypotension. No intergroup differences were manifested in intra-abdominal complications (fistula/leak, abscess, pancreatitis, intestinal obstruction, wound dehiscence)...
July 1993: American Journal of Surgery
S C Nahas
The author presents a retrospective descriptive study of 313 colon injuries treated surgically. The lesions were caused by fire arms and knife wounds, impalement and closed abdominal trauma. Results were analysed considering factors directly involved with the outcome in terms of morbidity and mortality. They were age, sex, ethnic group, span of time between traumatic event and surgery, type and anatomical location of colonic lesions and associated injuries, degree of contamination of the abdominal cavity, surgical procedure, intraabdominal and surgical wound, post-operative complications, systemic complications, evolution and results of post-mortem examinations in cases of death...
September 1993: Revista do Hospital Das Clínicas
M S Kulkarni, M M Hindlekar
BACKGROUND: Management of civilian colonic trauma remains controversial. AIM: To determine prognostic factors in patients with civilian colonic trauma undergoing different modes of therapy. METHODS: Sixty-five patients with colonic injuries were retrospectively analyzed. RESULTS: Right and left colon injuries were present in 30 and 35 cases respectively. Colon-related complications occurred in 27.7%. One death (1.5%) was directly due to colonic injuries...
April 1995: Indian Journal of Gastroenterology: Official Journal of the Indian Society of Gastroenterology
K Abu-Dalu, A Ayalon, A L Durst, N J Saltz
Seven patients with duodenal injuries following penetrating or blunt upper abdominal trauma are presented. In five, debridement, primary closure and drainage were performed; the postoperative course was uneventful. One other patient developed complications as a results of multiple trauma not directly related to duodenal injury. The seventh patient suffered from duodenal and small bowel fistulas, which closed after prolonged nonoperative treatment. All patients survived. Early diagnosis through accurate exploration and appropriate surgical interventions is essential to reduce morbidity and mortality in cases of serious insult to the duodenum...
April 1981: International Surgery
A Cook, B A Levine, T Rusing, K R Sirinek, H V Gaskill
Several recent reports have described management of penetrating colon wounds with primary closure, exteriorization, and early return to the abdominal cavity. Since this procedure was not the technique practiced at our institution, we reviewed our five-year experience with 207 patients with such wounds to determine whether a change in methods was warranted. The patients, predominantly young and male, were often victims of gunshots or stabbings. Associated injuries (intra-abdominal, 64%; extra-abdominal, 35%) were frequent...
May 1984: Archives of Surgery
S M George, T C Fabian, E C Mangiante
During a 5 year period, 137 patients who sustained intraperitoneal colon injuries were retrospectively analyzed. One hundred fourteen were considered for evaluation. The method of colon wound management and infectious complications thought to be secondary to the colon wound were reviewed. These patients were admitted to the trauma service and underwent exploratory laparotomy for their injuries. The penetrating abdominal trauma index, as well as other risk factors, were evaluated for their efficacy in predicting potential complications associated with the colon wound...
July 1988: American Journal of Surgery
N Nelken, F Lewis
The management of penetrating colon injury has been frequently debated in the literature, yet few reports have evaluated primary closure versus diverting colostomy in similarly injured patients. Diverting colostomy is the standard of care when mucosal penetration is present, but primary closure in civilian practice has generally had excellent results, although it has been restricted to less severely injured patients. Because the degree of injury may influence choice of treatment in modern practice, various indices of injury severity have been proposed for assessment of patients with penetrating colon trauma...
April 1989: Annals of Surgery
S B Frame, C A Ridgeway, J C Rice, N E McSwain, M D Kerstein
The preferred method for the treatment of penetrating injuries to the colon remains a source of controversy. In our retrospective review of 65 patients with penetrating colon injuries, 33 patients were managed by colostomy formation, 30 were treated by primary repair, and two had exteriorized repair with early return to the abdominal cavity (drop back). The anatomic location of injury was ascending colon in 19 (29%), transverse colon in 20 (31%), descending colon in 22 (34%), and multiple sites in four (6%)...
September 1989: Southern Medical Journal
C A Ridgeway, S B Frame, J C Rice, G A Timberlake, N E McSwain, M D Kerstein
The charts of 81 consecutive patients with penetrating colonic trauma were reviewed. Sixty-five patients were considered for evaluation. Penetrating abdominal trauma index, associated injuries, length of operative procedure, wounding agent, length of hospital stay, method of treatment, and septic complications were evaluated. Twenty-eight patients were treated with colostomy at the site of injury: five with diverting colostomy proximal to repair, 30 with primary repair (either single or multiple injuries), and two with exteriorization and early drop back...
December 1989: Diseases of the Colon and Rectum
C J Huang, T J Huang, H M Chan, Y F Juang, Y S Huang, J S Hsieh
From July 1982 to June 1989, 64 patients with trauma involving a colon and rectum operated on at the Kaohsiung Medical College Hospital were retrospectively reviewed. Their ages ranged from 14 to 90 years (mean 43.6 +/- 17.6 years); 48 were male, 16 female. Thirty-four (53.1%) had penetrating injuries, 30 (46.9%) had blunt injuries. Twenty-six (86.7%) blunt injuries and 7 (20.6%) penetrating injuries involved various associated injuries. There was a significantly greater number of associated organ injury in cases of blunt trauma...
May 1990: Gaoxiong Yi Xue Ke Xue za Zhi, the Kaohsiung Journal of Medical Sciences
W F Fallon
The role of colostomy in the treatment of abdominal trauma has changed over the past several decades. Primarily as a result of its successful use in military settings, colostomy initially was the mainstay of treatment for penetrating injury to the colon, rectal injury, and some forms of blunt trauma. Subsequent civilian experience with the techniques of primary repair of penetrating colon injury resulted in a decrease in the number of colostomies performed. Coupled with this experience, early data on adverse outcome from colostomy closure tended to support the trend of the ever-diminishing place of colostomy for trauma...
November 1992: Diseases of the Colon and Rectum
R E Falcone, S R Wanamaker, S A Santanello, L C Carey
This prospective, randomized, controlled study was undertaken to compare primary repair or anastomosis with intracolonic bypass vs. ostomy in severe colon and intraperitoneal rectal injury. Patients were randomized at surgery following confirmation of injury. Data collected included demographics, mechanism and location of injury, trauma score (TS), injury severity score (ISS), penetrating abdominal trauma index (PATI), complications, length of hospital stay, and hospital charges. Twenty-two patients were studied: 11 with intracolonic bypass and 11 controls...
October 1992: Diseases of the Colon and Rectum
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