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Dilday J, Chien CY, Lewis MR, Benjamin ER, Demetriades D. Proximal protective diverting ostomy following colon anastomosis for penetrating trauma may not be protective: A matched cohort study. Am J Surg 2024; 228:237-241. [PMID: 37863797 DOI: 10.1016/j.amjsurg.2023.10.026] [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: 09/05/2023] [Revised: 09/28/2023] [Accepted: 10/05/2023] [Indexed: 10/22/2023]
Abstract
INTRODUCTION Despite the shift toward liberal primary anastomosis in penetrating colon injuries, some surgeons recommend a protective diverting ostomy (DO) proximal to the anastomosis. This study evaluates the effect of DO on outcomes in patients undergoing colon resection and anastomosis following penetrating trauma. METHODS The TQIP database (2013-2018) was queried for penetrating colon injuries undergoing colectomy and anastomosis. Patients receiving DO were propensity matched to patients without diverting ostomy (woDO) (1:3). Outcomes were compared between groups. RESULTS After matching, 89 DO patients were analyzed. The DO group had more surgical site infections (32 % vs. 21 %; p < 0.05) and longer hospital stay (20 [13-27] vs. 15 [9-25]; p < 0.05) compared to the woDO group. Mortality and unplanned operations were similar between groups. CONCLUSIONS Diverting ostomy after colon resection and anastomosis is associated with increased infectious complications without decreasing unplanned operations or mortality. Its routine role in penetrating colon trauma needs reassessment.
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Affiliation(s)
- Joshua Dilday
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Chih Ying Chien
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA; Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan.
| | - Meghan R Lewis
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
| | - Elizabeth R Benjamin
- Department of Trauma and Surgical Critical Care, Grady Memorial Hospital, Atlanta, GA, USA.
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, CA, USA.
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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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Rocco B, Giorgia G, Simone A, Tommaso C, Mattia S, Stefano T, Ahmed E, Giorgio B, De Concilio B, Celia A, Salvatore M, Sighinolfi MC. Rectal Perforation During Pelvic Surgery. EUR UROL SUPPL 2022; 44:54-59. [PMID: 36093319 PMCID: PMC9449548 DOI: 10.1016/j.euros.2022.04.006] [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] [Accepted: 04/06/2022] [Indexed: 12/01/2022] Open
Abstract
Rectal perforations during pelvic surgery are rare but serious complications. The occurrence of rectal involvement is generally lower than that of the involvement of other portions of the bowel. The urologic field is responsible for the majority of iatrogenic rectal injuries from pelvic surgery; general and gynecologic surgeries are prone to the occurrence as well, the latter especially in the case of rectal shaving for deep infiltrating endometriosis. Attention should be posed to the prevention of rectal injuries, especially in case of challenging or salvage procedures; some tricks may be recommended to avoid thermal and mechanical damages and to realize a safe dissection. Intraoperative detection of rectal injuries is of paramount importance; once confirmed, immediate management with the closure of the defect is recommended. In general, rectal injuries diagnosed after surgery are liable to significantly worse outcomes than those detected and managed intraoperatively. Patient summary Rectal perforation is a rare but possible complication of pelvic surgeries. The more challenging the procedure (ie, surgery for locally advanced tumors or after radiation therapy), the higher the risk of rectal lesion. Intraoperative management of the injury should be attempted, with direct repair of the defect with or without fecal diversion.
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Affiliation(s)
- Bernardo Rocco
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Corresponding author. Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy. Tel. +39 335 830 6522.
| | - Gaia Giorgia
- Department of Gynecology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Assumma Simone
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Calcagnile Tommaso
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy,Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
| | - Sangalli Mattia
- Department of Urology, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Terzoni Stefano
- SIG Group on Continence Care, European Association of Urology Nurses, ASST Santi Paolo e Carlo, University of Milan, Milan, Italy
| | - Eissa Ahmed
- Department of Urology, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | | | - Antonio Celia
- San Bassiano Hospital, Bassano Del Grappa, Vicenza, Italy
| | - Micali Salvatore
- Department of Urology, University of Modena and Reggio Emilia, Modena, Italy
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Usability of fluorescence angiography with indocyanine green in the surgical management of penetrating abdominal trauma: A case series. INTERNATIONAL JOURNAL OF SURGERY OPEN 2021. [DOI: 10.1016/j.ijso.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Cheng V, Schellenberg M, Inaba K, Matsushima K, Warriner Z, Trust MD, Lam L, Demetriades D. Contemporary Trends and Outcomes of Blunt Traumatic Colon Injuries Requiring Resection. J Surg Res 2019; 247:251-257. [PMID: 31780053 DOI: 10.1016/j.jss.2019.10.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Revised: 09/30/2019] [Accepted: 10/02/2019] [Indexed: 01/29/2023]
Abstract
BACKGROUND After traumatic injury, primary anastomosis after colon resection has overtaken ostomy diversion. Improved technology facilitating primary anastomosis speed and integrity may have driven this change. Trends in ostomy versus anastomosis have yet to be quantified, and recent literature comparing outcomes is incomplete. METHODS The National Trauma Databank (2007-2014) was queried for all blunt colon injuries requiring resection. Patients were dichotomized into study groups based on whether they underwent ostomy creation. Ostomy creation frequency was compared over time. After subgrouping patients by colon injury location, multivariate regression adjusted for baseline characteristics and evaluated the impact of ostomy on clinical outcomes. RESULTS A total of 13,949 colon injuries requiring colectomy were identified. Ostomy frequency did not vary by study year (P = 0.536). Univariate analysis showed that patients undergoing ostomy were older (median, 40 versus 32; P < 0.001) and more often had comorbidities (65% versus 56%; P < 0.001). Multivariate analysis showed that ostomy creation was significantly associated with lower mortality after sigmoid colon injury (odds ratio, 0.512; P = 0.011) and higher rates of unplanned reoperation after transverse colon injury (odds ratio, 3.135; P = 0.048). Across all colon injuries, ostomies were significantly associated with longer hospital length of stay, intensive care unit length of stay, and ventilator days. CONCLUSIONS Ostomy creation for colonic injury has reached an equilibrium trough. The impact of ostomy creation varies by not only clinical outcome but also injury location. Further study is needed to define the optimal surgical management for blunt colon injuries requiring resection.
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Affiliation(s)
- Vincent Cheng
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Morgan Schellenberg
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California.
| | - Kenji Inaba
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Kazuhide Matsushima
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Zachary Warriner
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Marc D Trust
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Lydia Lam
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
| | - Demetrios Demetriades
- Division of Trauma and Surgical Critical Care, LAC+USC Medical Center, University of Southern California, Los Angeles, California
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6
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Leevan E, Carmichael JC. Iatrogenic bowel injury (early vs delayed). SEMINARS IN COLON AND RECTAL SURGERY 2019. [DOI: 10.1016/j.scrs.2019.100688] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Lasinski AM, Gil L, Kothari AN, Anstadt MJ, Gonzalez RP. Defining Outcomes after Colon Resection in Blunt Trauma: Is Diversion or Primary Anastomosis More Favorable? Am Surg 2018. [DOI: 10.1177/000313481808400838] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Previous literature demonstrates the safety of primary repair in penetrating colon injury requiring resection, without the creation of a diverting ostomy. It is unknown whether a similar approach can be applied to patients with blunt colon injury. The aim of this study was to measure outcomes in patients who underwent colon resection with and without ostomy creation after blunt trauma injury to help direct future management. Using the National Trauma Data Bank for years 2008 to 2012, we identified patients with blunt trauma mechanisms who underwent colectomy. Patients were stratified into two groups: primary anastomosis and diversion with ostomy. Primary outcome was inpatient mortality. Secondary outcomes included length of stay and perioperative complications. All risk-adjusted analyses were performed using logistic regression with consideration of interactions. Five hundred eighty-one observations met our inclusion criteria. Baseline characteristics between the two groups were similar with the exception of age (37.3 vs 42.2 years, P < 0.001) and admission Glasgow coma score (13.2 vs 12.1, P = 0.002). Risk-adjusted mortality for the two groups was not statistically significant (2.3% vs 3.0%, P = 0.63); however, patients with primary anastomosis had a shorter length of stay (18.2 vs 28.1, P < 0.001), fewer days in the intensive care unit (10.9 vs 16.2, P < 0.001), and fewer ventilator days (10.5 vs 14.6, P = 0.01). In patients requiring colon resection after blunt trauma, mortality is not different for those who receive a primary anastomosis versus ostomy. Patients without diversion had shorter hospital stays, intensive care unit days, and ventilator days. These data support that primary anastomosis is safe in this patient population.
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Affiliation(s)
- Alaina M. Lasinski
- One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Division of Trauma, Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Lindsay Gil
- One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Stritch School of Medicine, Loyola University Chicago, Maywood, Illinois
| | - Anai N. Kothari
- One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Division of Trauma, Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Michael J. Anstadt
- One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Division of Trauma, Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
| | - Richard P. Gonzalez
- One: MAP Division of Clinical Informatics and Analytics, Loyola University Medical Center, Maywood, Illinois
- Division of Trauma, Critical Care and Burns, Department of Surgery, Loyola University Medical Center, Maywood, Illinois
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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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Oosthuizen GV, Weale R, Kong VY, Bruce JL, Urry RJ, Laing GL, Clarke DL. The effect of a concomitant renal injury on the outcome of colonic trauma. Am J Surg 2017; 216:230-234. [PMID: 29287924 DOI: 10.1016/j.amjsurg.2017.11.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 11/21/2017] [Accepted: 11/28/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND The management of colon injuries has steadily evolved over the course of the last half century. So too has the management of renal trauma. It is not clear from the literature as to whether concomitant colon and renal injuries carry increased risk of morbidity and mortality, and whether this combination of injuries necessitates a specifically tailored management approach. METHODS A retrospective review was carried out for the period January 2012 to December 2016. All patients over the age of 18 years who were subjected to laparotomy for penetrating trauma (gunshot wounds or stab wounds) and who sustained an intra-operatively proven colonic injury were included in this study. Operative management and outcomes were investigated. A direct comparison was made between patients with a combined colonic and renal injury and those with only a colonic injury. RESULTS Over the five-year period a total of 268 patients sustained a colonic injury. The 239 patients with a colonic injury (Group A) were compared to the 29 patients with a combined colonic and renal injury (Group B). Regarding the management of the colonic injuries, there were no differences in the rates of primary repair, anastomosis, exteriorization, or damage control surgery between groups A and B. As for the management of the renal injury, 14 were not explored at laparotomy; in 12 a nephrectomy was performed and in 3 the renal injury was repaired. The nephrectomy cohort were more likely to have undergone damage control surgery, to be admitted to ICU, to receive a colostomy, and had higher mortality. While there was no difference in the need for damage control surgery or mortality between groups, Group B had a significantly greater need for ICU admission. Morbidity was similar between the two groups - in particular, there was no difference in the rates of either gastro-intestinal complications or acute kidney injury between the two groups. CONCLUSION In patients with combined colon and renal injuries, it seems reasonable to treat each organ on its own merit, without the expectation of increased morbidity or mortality. In the non-damage control setting, most colonic injuries may be safely repaired, and a peri-renal haematoma that is not expanding or actively bleeding may be safely left alone.
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Affiliation(s)
- G V Oosthuizen
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
| | - R Weale
- Department of General Surgery, Wessex Deanery, United Kingdom.
| | - V Y Kong
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
| | - J L Bruce
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
| | - R J Urry
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
| | - G L Laing
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa.
| | - D L Clarke
- Pietermaritzburg Metropolitan Trauma Service, Department of Surgery, University of KwaZulu-Natal, Durban, South Africa; Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
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10
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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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12
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Laparoscopic-assisted approach for penetrating abdominal trauma: A solution for multiple bowel injuries. Int J Surg 2017. [DOI: 10.1016/j.ijsu.2017.06.040] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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13
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Hunt PJ, Koons GL, Murri M, Todd SR. Damage Control Surgery and the Management of a Cholecystocolic Fistula. Am Surg 2017. [DOI: 10.1177/000313481708300409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Patrick J. Hunt
- Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston, Texas; and the Medical Scientist Training Program Baylor College of Medicine Houston, Texas
| | - Gerry L. Koons
- Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston, Texas; and the Medical Scientist Training Program Baylor College of Medicine Houston, Texas
| | - Michael Murri
- Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston, Texas; and the Medical Scientist Training Program Baylor College of Medicine Houston, Texas
| | - S. Rob Todd
- Michael E. DeBakey Department of Surgery Baylor College of Medicine Houston, Texas; and the Medical Scientist Training Program Baylor College of Medicine Houston, Texas
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14
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Cheong JY, Keshava A. Management of colorectal trauma: a review. ANZ J Surg 2017; 87:547-553. [DOI: 10.1111/ans.13908] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2016] [Revised: 12/14/2016] [Accepted: 12/18/2016] [Indexed: 12/17/2022]
Affiliation(s)
- Ju Yong Cheong
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School; The University of Sydney; Sydney New South Wales Australia
| | - Anil Keshava
- Department of Colorectal Surgery, Concord Institute of Academic Surgery, Concord Clinical School; The University of Sydney; Sydney New South Wales 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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Lazovic R, Radojevic N, Curovic I. Performance of primary repair on colon injuries sustained from low-versus high-energy projectiles. J Forensic Leg Med 2016; 39:125-9. [PMID: 26874437 PMCID: PMC5225958 DOI: 10.1016/j.jflm.2016.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/13/2015] [Accepted: 01/01/2016] [Indexed: 10/22/2022]
Abstract
Among various reasons, colon injuries may be caused by low- or high-energy firearm bullets, with the latter producing a temporary cavitation phenomenon. The available treatment options include primary repair and two-stage management, but recent studies have shown that primary repair can be widely used with a high success rate. This paper investigates the differences in performance of primary repair on these two types of colon injuries. Two groups of patients who sustained colon injuries due to single gunshot wounds, were retrospectively categorized based on the type of bullet. Primary colon repair was performed in all patients selected based on the inclusion and exclusion criteria (Stone and Fabian's criteria). An almost absolute homogeneity was attained among the groups in terms of age, latent time before surgery, and four trauma indexes. Only one patient from the low-energy firearm projectile group (4%) developed a postsurgical complication versus nine patients (25.8%) from the high-energy group, showing statistically significant difference (p = 0.03). These nine patients experienced the following postsurgical complications: pneumonia, abscess, fistula, suture leakage, and one multiorgan failure with sepsis. Previous studies concluded that one-stage primary repair is the best treatment option for colon injuries. However, terminal ballistics testing determined the projectile's path through the body and revealed that low-energy projectiles caused considerably lesser damage than their high-energy counterparts. Primary colon repair must be performed definitely for low-energy short firearm injuries but very carefully for high-energy injuries. Given these findings, we suggest that the treatment option should be determined based not only on the bullet type alone but also on other clinical findings.
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Affiliation(s)
- Ranko Lazovic
- Faculty of Medicine, University of Montenegro, Clinical Center of Montenegro, Podgorica, Montenegro.
| | - Nemanja Radojevic
- Faculty of Medicine, University of Montenegro, Clinical Center of Montenegro, Podgorica, Montenegro.
| | - Ivana Curovic
- Faculty of Medicine, University of Montenegro, Clinical Center of Montenegro, Podgorica, Montenegro.
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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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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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