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Altiok M, Tümer H, Sarıtaş AG. Evaluation of the predictive effects of trauma scoring systems in colorectal injuries. Eur J Trauma Emerg Surg 2024; 50:269-274. [PMID: 37555993 DOI: 10.1007/s00068-023-02328-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Accepted: 07/05/2023] [Indexed: 08/10/2023]
Abstract
INTRODUCTION Colorectal injuries following traumas are significant causes of morbidity and mortality. This study aimed to evaluate the predictive effect of trauma scoring systems on mortality and morbidity in patients with post-traumatic colon injury. METHODS The records of 145 patients with colon trauma treated at Seyhan State Hospital between January 1, 2010, and January 1, 2020, were retrospectively analyzed. Injury Seriousness Score (ISS), Revised Trauma Score (RTS), Trauma Injury Severity Score (TRISS), and Colon Injury Score (CIS) scores were calculated for all patients. The predictive effects of scoring systems on primary outcomes of surgical treatment, complication rates, mortality, and anastomotic leaks were evaluated. RESULTS The mean age of the patients was 36.1 (SD ± 16.6), and the female/male ratio was 37/108. Anastomotic leakage occurred in 12 (8.2%) patients, and complications were observed in 57 (39.3%) patients. Seven (4.7%) patients died. A statistically significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. Increases in ISS and decreases in RTS and TRISS were associated with increased morbidity and mortality, but these relationships were not statistically significant. CONCLUSION A significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. The study suggests the need for a specific scoring system for evaluating the prognostic status in colon traumas, as ISS, RTS, and TRISS scores were not found to be significantly predictive of outcomes in this patient population.
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Affiliation(s)
- Merih Altiok
- Department of General Surgery, Ortadoğu Hospital, 01250, Seyhan/Adana, Turkey.
| | - Haluk Tümer
- Department of General Surgery, Seyhan State Hospital, Adana, Turkey
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Cao B, Zhao RY, Li HH, Xu XM, Cui H, Deng H, Chen L, Wei B. Oral administration of asparagine and 3-indolepropionic acid prolongs survival time of rats with traumatic colon injury. Mil Med Res 2022; 9:37. [PMID: 35791006 PMCID: PMC9258171 DOI: 10.1186/s40779-022-00397-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 06/20/2022] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Traumatic colon injury (TCI) is a common disease during wartime. Prolongation of posttraumatic survival time is an effective approach to patient outcome improvement. However, there is a lack of basic research in this field. This study aimed to elucidate the mechanisms underlying TCI progression and to develop novel regimens to buy time for TCI patients on the battlefield. METHODS A total of 669 Sprague-Dawley rats were used in this study. Surgical colon incision was performed to generate the TCI rat model. The landscape of colon microbiota compositions was depicted using 16S rRNA sequencing and metabolites in the intestinal contents were detected by metabolomics profiling. The signaling transduction in the intestinal epithelium was investigated using antibody microarrays and Western blotting. The enzyme-linked immunosorbent assay was conducted to measure the levels of interleukin-6 and tumor necrosis factor-α in intestines and plasma for the detection of inflammatory responses. Diamine oxidase, D-lactate and endotoxin in plasma and protein expression of zonula occludens 1 and occludin were selected as the indicators of intestinal barrier permeability. To investigate alterations of microbiota symbiosis, the relative abundances of specific bacterial genera were detected using quantitative real-time PCR. RESULTS As a type of lethal injury, TCI induced acute disruption of intestinal homeostasis, characterized by inflammatory responses, intestinal barrier hyperpermeability and microbiota dysbiosis (P < 0.05). Significant alterations in bacterial metabolic patterns were detected with decreases in many metabolites. After a series of screenings, we found that oral administration of asparagine (Asn) and 3-indolepropionic acid (IPA) effectively prolonged posttraumatic survival time [Asn plus IPA vs. Vehicle: hazard ratio (HR) = 0.105, 95% CI 0.031-0.356, P = 0.0003] and restored intestinal homeostasis in TCI rats (P < 0.05). Mechanistically, this combinational strategy protected the rats against TCI through synergistic activation of Akt signaling in the intestinal epithelium (P < 0.05). CONCLUSIONS Abrupt dysregulation of intestinal homeostasis plays a critical role in the progression toward TCI-induced death. Oral administration of Asn plus IPA may serve as an effective regimen to restore intestinal functions and prolong the posttraumatic survival time.
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Affiliation(s)
- Bo Cao
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.,Medical School of Chinese PLA, Beijing, 100853, China
| | - Rui-Yang Zhao
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.,Medical School of Chinese PLA, Beijing, 100853, China
| | - Hang-Hang Li
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.,Medical School of Chinese PLA, Beijing, 100853, China
| | - Xing-Ming Xu
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Hao Cui
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Huan Deng
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.,Medical School of Chinese PLA, Beijing, 100853, China
| | - Lin Chen
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China
| | - Bo Wei
- Department of General Surgery, the First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
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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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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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Colorectal emergencies and related complications: a comprehensive imaging review--noninfectious and noninflammatory emergencies of colon. AJR Am J Roentgenol 2015; 203:1217-29. [PMID: 25415698 DOI: 10.2214/ajr.13.12323] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
OBJECTIVE In this article, we illustrate imaging findings of colorectal emergencies encountered in the acute setting that are primarily noninfectious and noninflammatory in origin. Our review should enable the reader to identify and understand common colorectal emergencies and related complications in clinical practice. CONCLUSION The diagnosis of colorectal emergencies is mostly straightforward, but it can be challenging because of the overlap of presenting symptoms and imaging findings. Therefore, it is essential to clarify the cause, narrow the differential diagnosis, and identify associated complications.
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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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Hatch Q, Causey M, Martin M, Stoddard D, Johnson E, Maykel J, Steele S. Outcomes after colon trauma in the 21st century: an analysis of the U.S. National Trauma Data Bank. Surgery 2013; 154:397-403. [PMID: 23889967 DOI: 10.1016/j.surg.2013.05.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2012] [Accepted: 05/10/2013] [Indexed: 01/02/2023]
Abstract
INTRODUCTION Most colon trauma data arise from institutional series that provide descriptive analysis. We investigated the outcome of these patients by analyzing a nationwide database. METHODS We queried the U.S. National Trauma Data Bank (2007-2009) using primary International Classification of Diseases, 9th edition, Clinical Modification codes to identify colon injuries. Outcomes were stratified by injury mechanism (blunt versus penetrating), segment of colon injured, and management strategy (diversion versus in continuity). RESULTS There were 6,817 patients who suffered primary colon injuries; 82% were male and 48% experienced blunt injuries. Blunt colon trauma patients were older, had lengthier intensive care stays, and greater rates of morbidity and mortality than those with penetrating injuries (all P < .05). Nonspecified injuries were the most common (36%), followed by transverse colon injuries (24%). The overall fecal diversion rate was 9%, with the highest rates seen in patients with sigmoid colon injuries (15%). Diverted patients were older, had higher injury severity scores, and increased mortality (22% vs 12%; P < .001). Multivariate analysis found that neither mechanism nor fecal diversion were independently associated with increased morbidity or mortality. CONCLUSION Sigmoid colon injuries seem to be managed with fecal diversion more often than other segmental injuries. Neither blunt mechanism nor fecal diversion were independently associated with adverse outcomes in colon trauma.
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Affiliation(s)
- Quinton Hatch
- Department of Surgery, Madigan Army Medical Center, Tacoma, WA 98431, USA.
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Sharma SK, Hadda V, Mathur P, Gulati V, Sahney C. Profile of micro-organisms in intensive care unit of a level-1 trauma centre: A retrospective study. Indian J Crit Care Med 2013; 17:87-91. [PMID: 23983413 PMCID: PMC3752873 DOI: 10.4103/0972-5229.114827] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Background: Patients with trauma usually require highly specialized care in ICU and many times their recovery is complicated by infections. Aim of this study was to determine the profile of pathogens and their impact on outcome among these patients. Materials and Methods: The clinical records of 101 consecutive patients who were admitted for more than 48-hrs in ICU during Jun-Dec 2007 were analyzed. Results: Total of 953 samples from blood, urine, BAL or pus/collection were subjected to cultures. From 276 samples, 299 organisms were isolated. Among pathogens Candida Spp. [89 (29%)] were the most common, followed by Acinetobacter Spp. [69 (23%)], Pseudomonas Spp. [63 (21%)], Klebsiella Spp. [31 (10%)], coagulase negative Staphylococcus aureus [16 (5%)], E coli [12 (4%)], Enterobacter Spp. [7 (2%)], S aureus [6 (2%)], Enterococcus Spp. [5 (2%)], Citrobacter Spp. [2 (0.6%)], S maltophila [1 (0.3%)] and Providentia Spp. [1 (0.3%)]. For gram negative pathogens drug-resistance rates were as follows: Fluoroquinolones, 76%; 3rd generation cephalosporins, 74%; aminoglycosides, 66%; β-lactams/β-lactamase inhibitors combinations, 64%; and carbapenems, 50%. Among these 27% of pathogens were resistant to all 5 classes of drugs. 58% of Staphylococcus aureus were methicillin-resistant whereas 85% of coagulase negative Staphylococcus were methicillin resistant. The mortality was higher among patients in whom pathogens were isolated [Odd's Ratio (OR) 0.185; 95% confidence interval (CI) 0.049-0.640; P = 0.002]. Conclusions: Isolation of multi-drug resistant pathogens is common among trauma patients admitted in ICU and is associated with increased mortality and could impact on the consumption of hospital resources. The importance of high rate of fungal isolation needs to be studied among these patients.
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Affiliation(s)
- Shefali K Sharma
- Department of Internal Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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