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1
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Mouradian GP, Lake Z, Winfield R. Rectal necrosis in the setting of critical illness and burn. Trauma Case Rep 2023; 47:100886. [PMID: 37654702 PMCID: PMC10466907 DOI: 10.1016/j.tcr.2023.100886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/02/2023] Open
Abstract
The rectum is an anatomically protected and well vascularized structure. Injury to the rectum is usually the result of penetrating perineal mechanisms or reported scalding enemas. Here, we report a case of isolated rectal necrosis following a 72 % total body surface area burn that resulted from a motor vehicle crash. The patient's rectal injury was managed with open resection, left in discontinuity and ultimately expired. In presenting this case, we hope to share an unusual development in a patient with critical illness and guide future care.
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Affiliation(s)
- Gregory P. Mouradian
- The University of Kansas Medical Center, Department of Surgery, 3901 Rainbow Blvd, Mail Stop 2005, Kansas City, KS 66160, USA
| | - Zoe Lake
- The University of Kansas Medical Center, Department of Surgery, 3901 Rainbow Blvd, Mail Stop 2005, Kansas City, KS 66160, USA
| | - Robert Winfield
- The University of Kansas Medical Center, Department of Surgery, 3901 Rainbow Blvd, Mail Stop 2005, Kansas City, KS 66160, USA
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2
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Jambor M, Irwin M, Kirkland O, Seton R. Complete transection of the descending colon following blunt abdominal trauma. BMJ Case Rep 2023; 16:e254553. [PMID: 37280009 PMCID: PMC10255016 DOI: 10.1136/bcr-2023-254553] [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] [Indexed: 06/08/2023] Open
Abstract
We present the case of a man in his 30s who was crushed between two vehicles sustaining blunt trauma to his lower limbs and torso. The patient was in shock on arrival to the emergency department, and immediate resuscitation was given with massive transfusion protocol activation. Once the patient's haemodynamic status was stabilised, a CT scan revealed a complete colon transection. The patient was taken to the operating theatre where a midline laparotomy was performed, and the transected descending colon was managed with a segmental resection and handsewn anastomosis. The patient followed an unremarkable postoperative course, with bowels opening on day 8 postoperatively. Colon injuries are rare following blunt abdominal trauma, and a delay in diagnosis may lead to increased morbidity and mortality. As such, a low threshold for surgical intervention is recommended.
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Affiliation(s)
- Maxwell Jambor
- Acute Surgical Unit, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Matthew Irwin
- Acute Surgical Unit, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Olivia Kirkland
- Acute Surgical Unit, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
| | - Rebecca Seton
- Acute Surgical Unit, Northern Sydney Local Health District, St Leonards, New South Wales, Australia
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3
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Martínez-Hincapié C, Sierra-Jaramillo JI, Carvajal-López A, Santiago Salazar-Ochoa S, Posada-Moreno P, Llano-Herrera M. Trauma de recto penetrante: revisión de tema. REVISTA COLOMBIANA DE CIRUGÍA 2022. [DOI: 10.30944/20117582.941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Introducción. En la actualidad, el trauma de recto continúa siendo una situación clínica compleja y temida por ser potencialmente mortal. Su detección y manejo temprano es la piedra angular para impactar tanto en la mortalidad como en la morbilidad de los pacientes. Hoy en día, aun existe debate sobre la aproximación quirúrgica ideal en el trauma de recto y las decisiones de manejo intraoperatorias se ven enormemente afectadas por la experiencia y preferencias del cirujano.
Métodos. Se realizó una búsqueda de la literatura en las bases de datos de PubMed, Clinical Key, Google Scholar y SciELO utilizando las palabras claves descritas y se seleccionaron los artículos mas relevantes publicados en los últimos 20 años; se tuvieron en cuenta los artículos escritos en ingles y español.
Discusión. El recto es el órgano menos frecuentemente lesionado en trauma, sin embargo, las implicaciones clínicas que conlleva pasar por alto este tipo de lesiones pueden ser devastadoras para el paciente. Las opciones para el diagnóstico incluyen el tacto rectal, la tomografía computarizada y la rectosigmoidoscopia. El manejo quirúrgico va a depender de la localización, el grado de la lesión y las lesiones asociadas.
Conclusión. El conocimiento de la anatomía, el mecanismo de trauma y las lesiones asociadas permitirán al cirujano realizar una aproximación clínico-quirúrgica adecuada que lleve a desenlaces clínicos óptimos de los pacientes que se presentan con trauma de recto.
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4
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Ordoñez CA, Parra MW, Caicedo Y, Padilla N, Angamarca E, Serna JJ, Rodríguez-Holguín F, García A, Salcedo A, Pino LF, González-Hadad A, Herrera MA, Quintero L, Hernández F, Franco MJ, Aristizábal G, Toro LE, Guzmán-Rodríguez M, Coccolini F, Ferrada R, Ivatury R. Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent? Colomb Med (Cali) 2021; 52:e4114425. [PMID: 34188327 PMCID: PMC8216049 DOI: 10.25100/cm.v52i2.4425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.
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Affiliation(s)
- Carlos A Ordoñez
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Michael W Parra
- Broward General Level I Trauma Center, Department of Trauma Critical Care, Fort Lauderdale, FL - USA
| | - Yaset Caicedo
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | - Natalia Padilla
- Fundación Valle del Lili, Centro de Investigaciones Clínicas (CIC), Cali, Colombia
| | | | - José Julián Serna
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Fernando Rodríguez-Holguín
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Alberto García
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia
| | - Alexander Salcedo
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia.,Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Universidad Icesi, Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Luis Fernando Pino
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of 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, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Mario Alain Herrera
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - Laureano Quintero
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Fabian Hernández
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Hospital Universitario del Valle, Department of Surgery, Division of Trauma and Acute Care Surgery, Cali, Colombia
| | - María Josefa Franco
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Gonzalo Aristizábal
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Luis Eduardo Toro
- Fundación Valle del Lili, Department of Surgery, Division of Trauma and Acute Care Surgery. Cali, Colombia
| | - Mónica Guzmán-Rodríguez
- Universidad de Chile, Facultad de Medicina, Instituto de Ciencias Biomédicas, Santiago de Chile, Chile
| | - Federico Coccolini
- Pisa University Hospital, Emergency and Trauma Surgery, Department of General, Pisa, Italy
| | - Ricardo Ferrada
- Universidad del Valle, Facultad de Salud, Escuela de Medicina, Division of Trauma and Acute Care Surgery, Department of Surgery. Cali, Colombia.,Centro Médico Imbanaco, Cali, Colombia
| | - Rao Ivatury
- Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA
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Yamamoto Y, Miyagawa Y, Kitazawa M, Takahata S, Aoyagi S, Hondo N, Koyama M, Nakamura S, Tokumaru S, Muranaka F, Soejima Y. Types and site distributions of intestinal injuries in seat belt syndrome. TRAFFIC INJURY PREVENTION 2020; 21:442-446. [PMID: 32886011 DOI: 10.1080/15389588.2020.1774565] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 05/19/2020] [Accepted: 05/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Intestinal injuries in seat belt syndrome are relatively uncommon but can be potentially lethal due to accompanying peritonitis and hemorrhaging. It can be difficult to identify the exact injury sites of the intestine as multiple areas are often damaged and massive intraperitoneal hemorrhaging may make it challenging to determine causal bleeding points of mesenteric injuries. This study aimed to clarify the incidence and distribution of intestinal injuries in seat belt syndrome. METHODS We retrospectively reviewed the clinical records of 25 patients who underwent laparotomy for suspected intestinal injuries due to seat belt syndrome during a frontal impact. The incidence and distribution of the sites of intestinal injuries, as well as associated injuries, were investigated. Intestinal injuries were divided into bowel and mesenteric injuries. Additionally, bowel injuries were classified into two types: perforation and non-perforation (seromuscular tears/intramural hematomas). Regarding the injured sites, the small intestine was divided into the following three parts: (1) the ligament of Treitz (100-cm distal from the ligament [proximal jejunum]), (2) the ileocecal valve (100-cm proximal from the valve [distal ileum]), and (3) the intermediate area between those two regions (jejunoileal junction). RESULTS In total, there were 64 major injuries among 25 patients requiring surgical intervention: 34 bowel injuries (20 perforations and 14 non-perforations) and 30 mesenteric injuries. Significantly more bowel perforations occurred in the small intestine (1 [interquartile range (IQR), 0-1]) than in the large intestine (0 [IQR, 0-0]) (p = 0.003). Similarly, significantly more mesenteric injuries occurred in the small intestine (1 [IQR, 0-1.25]) than in the large intestine (0 [IQR, 0-0]) (p < 0.001). Specific sites of the mesenteric injuries in the small intestine included the jejunoileal junction (0 [IQR, 0-1]) and distal ileum (0 [IQR, 0-1]); the jejunoileal junction was significantly more vulnerable than the proximal jejunum (0 [IQR, 0-0]) (p = 0.015). CONCLUSIONS In patients with seat belt syndrome, the small intestine was more vulnerable to perforation and mesenteric injury than the large intestine. Additionally, for mesenteric injuries, the jejunoileal junction was more likely to be damaged than the proximal jejunum.
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Affiliation(s)
- Yuta Yamamoto
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yusuke Miyagawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Masato Kitazawa
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shugo Takahata
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Seigo Aoyagi
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Nao Hondo
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Makoto Koyama
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Satoshi Nakamura
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Shigeo Tokumaru
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Futoshi Muranaka
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
| | - Yuji Soejima
- Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation and Pediatric Surgery, Department of Surgery, Shinshu University School of Medicine, Matsumoto, Nagano, Japan
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6
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Abstract
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. The historical management of traumatic colon injuries, common mechanisms of injury, demographics, presentation, assessment, diagnosis, management, and complications of traumatic colon injuries both in civilian and military practice are reviewed. The damage control revolution has added another layer of complexity to management with continued controversy.
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Affiliation(s)
- Cpt Lauren T. Greer
- Department of Surgery, General Surgery Service, Walter Reed National Military Medical Center, Bethesda, Maryland
| | | | - Maj Amy E. Vertrees
- Department of Surgery, General Surgery Service, Walter Reed National Military Medical Center, Bethesda, Maryland
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Uchino H, Kong V, Elsabagh A, Laing G, Bruce J, Manchev V, Clarke D. Contemporary management of rectal trauma - A South African experience. Injury 2020; 51:1238-1241. [PMID: 32127200 DOI: 10.1016/j.injury.2020.02.121] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2019] [Revised: 01/20/2020] [Accepted: 02/23/2020] [Indexed: 02/02/2023]
Abstract
INTRODUCTION The management of rectal trauma remains controversial. There are three modalities which have been used to manage these injuries; proximal diversion (PD), washout of the distal rectum (DRW) and presacral drainage (PSD). The EAST group tentatively advocate mandatory proximal diversion for extraperitoneal rectal injuries and omitting DRW or PSD. Other authors have suggested that diversion can be eschewed in patients with an intraperitoneal injury which can be primarily repaired. In light of all these controversies, this project set out to review our experience with rectal injuries over the last seven years with the objective of reviewing our use of PD, PSD and DRW. METHODS Patients aged greater than or equal to 15 years with rectal injuries during December 2012 to July 2019 were included. Patient demographics, mechanism of injury, management strategy (operative or non-operative), complications, patient residential status (urban or rural), hospital and intensive care duration of stay, and 30-day mortality rates were assessed. RESULTS During the study period, a total of 51 patients with a rectal injury were treated. There were 45 (88%) males and the median age was 29 (22-39) years. There were 7 (14%) blunt mechanisms, 41 (80%) penetrating mechanisms and 3 (6%) combined blunt and penetrating mechanisms. The median ISS was 13 (9-18). Of the 50 rectal injuries ultimately treated at our institution, there were 31 extraperitoneal and 14 intraperitoneal injuries. There were five combined intra and extraperitoneal injuries. A total of 21 rigid sigmoidoscopies and a single flexible sigmoidoscopy were performed. A total of 24 patients underwent a CT scan. There were 13 primary repairs and 45 PD. A single patient required a PSD. Of the 34 documented complications, 15 (44%) were related to sepsis and can be attributed to the rectal injury. The overall mortality rate was 11.8%. CONCLUSIONS Rectal injuries are associated with significant septic related morbidity and mortality. Although we have begun to avoid diversion in a small subset of patients with an intraperitoneal injury, we continue to perform PD for the vast majority of patients with a rectal injury. We do not perform DRW and PSD is used in highly selective cases.
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Affiliation(s)
- Hayaki Uchino
- Department of Surgery, Kurashiki Central Hospital, Okayama, Japan
| | - Victor Kong
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa.
| | | | - Grant Laing
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - John Bruce
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Vassil Manchev
- Department of Surgery, University of KwaZulu Natal, Durban, South Africa
| | - Damian Clarke
- Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa; Department of Surgery, University of KwaZulu Natal, Durban, South Africa.
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8
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Gash KJ, Suradkar K, Kiran RP. Rectal trauma injuries: outcomes from the U.S. National Trauma Data Bank. Tech Coloproctol 2018; 22:847-855. [PMID: 30264196 DOI: 10.1007/s10151-018-1856-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 09/12/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND There is a lack of general consensus and a little published data regarding the management of trauma-related rectal injuries and outcomes. The aim of the present study was to evaluate the surgical management and corresponding outcomes for this patient cohort, using a nationwide trauma database. METHODS Rectal injuries and procedures performed over a 2-year period (2013 and 2014) were identified through ICD-9 clinical modification codes, from the United States National Trauma Data Bank. Patient factors, management variables, and outcomes were evaluated. RESULTS Of 1.7 million patients, 1472 (0.1%) sustained a rectal injury; 81% male, median age 30 years (range 16-89 years) and 60% due to penetrating trauma. Seven hundred and seventy-eight (52.8%) had an isolated extraperitoneal injury and 694 (47.2%) had isolated Intraperitoneal or combined intra- and extraperitoneal injuries. Overall, 726 patients (49.3%) underwent fecal diversion. Injuries following blunt trauma were associated with higher injury severity scores (ISS), lower stoma rates, longer hospital and intensive-care unit (ICU) stay, and higher mortality rates than penetrating trauma (all p ≤ 0.001). Patients with stoma formation had lower mortality than undiverted patients (8.6 vs. 4.0%, p < 0.001) despite a higher ISS and more intraperitoneal injuries, but longer hospital and ICU stay (all p ≤ 0.001). On multivariate regression analysis, older age, higher ISS, intraperitoneal injury, and return to the ICU were independently associated with higher rates of mortality, while stoma formation was associated with a lower mortality rate. For isolated extraperitoneal rectal injuries, 494 patients (63.5%) were managed by resection/repair without stoma and had significantly lower overall postoperative morbidity rates (12.7 vs. 30.2%, p = 0.009) and shorter hospital stay (14 vs. 23 days, p < 0.001), than those who underwent resection/repair + stoma (n = 284; 36.5%), despite no significant difference in ISS (29 vs. 27, p = 0.780). There was no significant difference in mortality. CONCLUSIONS Our results showed that trauma-related rectal injuries are rare and there is wide variation in their management. These data support a low threshold for stoma formation in patients with intraperitoneal or combined injuries, while suggesting that isolated extraperitoneal defects may be safely managed without fecal diversion.
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Affiliation(s)
- K J Gash
- Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - K Suradkar
- Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA
- Mailman School of Public Health, Columbia University, New York, NY, USA
| | - R P Kiran
- Division of Colorectal Surgery, New York Presbyterian Hospital/Columbia University Medical Center, New York, NY, USA.
- Mailman School of Public Health, Columbia University, New York, NY, USA.
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9
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Skube SJ, Lindgren B, Fan Y, Jarosek S, Melton GB, McGonigal MD, Kwaan MR. Penetrating Colon Trauma Outcomes in Black and White Males. Am J Prev Med 2018; 55:S5-S13. [PMID: 30670202 PMCID: PMC7409984 DOI: 10.1016/j.amepre.2018.05.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/12/2018] [Accepted: 05/08/2018] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Racial disparities have been both published and disputed in trauma patient mortality, outcomes, and rehabilitation. In this study, the objective was to assess racial disparities in patients with penetrating colon trauma. METHODS The National Trauma Data Bank was searched for males aged ≥14years from 2010 through 2014 who underwent operative intervention for penetrating colon trauma. The primary outcomes for this study were stoma formation and transfer to rehabilitation; secondary outcomes were postoperative morbidity and mortality. Analyses were performed in 2016-2018. RESULTS There were 7,324 patients identified (4,916 black, 2,408 white). Black and white patients underwent fecal diversion with stoma formation at a similar rate (19.6% vs 18.5%, p=0.28). Black patients were more likely than white patients to be uninsured (self-pay; 37.1% vs 29.9%) and more likely to be injured by firearms (88.3% vs 70.2%, p<0.001), but had a lower overall postoperative morbidity rate (52.6% vs 55.3%, p=0.04). The odds of stoma formation (OR=0.92, 95% CI=0.78, 1.09, p=0.35) and the odds of transfer to rehabilitation (OR=1.03, 95% CI=0.82, 1.30, p=0.78) were similar for black versus white patients. CONCLUSIONS Black patients experienced similar rates of stoma formation and transfer to rehabilitation as white patients with penetrating colon trauma. Multivariate analysis confirmed expected findings that trauma severity increased the odds of receiving an ostomy and rehabilitation placement. The protocol-based management approach to emergency trauma care potentially decreases the risk for the racial biases that could lead to healthcare disparities. SUPPLEMENT INFORMATION This article is part of a supplement entitled African American Men's Health: Research, Practice, and Policy Implications, which is sponsored by the National Institutes of Health.
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Affiliation(s)
- Steven J Skube
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
| | - Bruce Lindgren
- Biostatistics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota
| | - Yunhua Fan
- Department of Urology, University of Minnesota, Minneapolis, Minnesota
| | - Stephanie Jarosek
- School of Public Health, University of Minnesota, Minneapolis, Minnesota
| | - Genevieve B Melton
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota; Institute for Health Informatics, University of Minnesota, Minneapolis, Minnesota
| | | | - Mary R Kwaan
- Department of Surgery, University of California, Los Angeles, California
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10
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Cox DRA, Fong J, Mori K. Tear of the entire length of the rectum with haemoperitoneum: an unusual cause of the acute abdomen. ANZ J Surg 2018; 89:E331-E332. [DOI: 10.1111/ans.14451] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 01/30/2018] [Indexed: 11/28/2022]
Affiliation(s)
- Daniel R. A. Cox
- General Surgery DepartmentNorthern Hospital Melbourne Victoria Australia
| | - Jonathan Fong
- General Surgery DepartmentNorthern Hospital Melbourne Victoria Australia
| | - Krinal Mori
- General Surgery DepartmentNorthern Hospital Melbourne Victoria Australia
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11
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Chamieh J, Prakash P, Symons WJ. Management of Destructive Colon Injuries after Damage Control Surgery. Clin Colon Rectal Surg 2017; 31:36-40. [PMID: 29379406 DOI: 10.1055/s-0037-1602178] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
After the World War II, fecal diversion became the standard of care for colon injuries, although medical, logistic, and technical advancements have challenged this approach. Damage control surgery serves to temporize immediately life-threatening conditions, and definitive management of destructive colon injuries is delayed until after appropriate resuscitation. The bowel can be left in discontinuity for up to 3 days before edema ensues, but the optimal repair window remains within 12 to 48 hours. Delayed anastomosis performed at the take-back operation or stoma formation has been reported with variable results. Studies have revealed good outcomes in those undergoing anastomosis after damage control surgery; however, they point to a subgroup of trauma patients considered to be "high risk" that may benefit from fecal diversion. Risk factors influencing morbidity and mortality rates include hypotension, massive transfusion, the degree of intra-abdominal contamination, associated organ injuries, shock, left-sided colon injury, and multiple comorbid conditions. Patients who are not suitable for anastomosis by 36 hours after damage control may be best managed with a diverting stoma. Failures are more likely related to ongoing instability, and the management strategy of colorectal injury should be based mainly on the patient's overall condition.
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Affiliation(s)
- Jad Chamieh
- Section of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri
| | - Priya Prakash
- Section of Trauma and Critical Care, Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - William J Symons
- Section of Acute and Critical Care Surgery, Department of Surgery, Washington University in St. Louis School of Medicine, St Louis, Missouri
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12
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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: 0.8] [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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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: 1.1] [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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15
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Dreizin D, Boscak AR, Anstadt MJ, Tirada N, Chiu WC, Munera F, Bodanapally UK, Hornick M, Stein DM. Penetrating Colorectal Injuries: Diagnostic Performance of Multidetector CT with Trajectography. Radiology 2016; 281:749-762. [DOI: 10.1148/radiol.2015152335] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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16
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Skinner OT, Cuddy LC, Coisman JG, Covey JL, Ellison GW. Temporary Rectal Stenting for Management of Severe Perineal Wounds in Two Dogs. J Am Anim Hosp Assoc 2016; 52:385-391. [PMID: 27685361 DOI: 10.5326/jaaha-ms-6350] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Perineal wounds in dogs present a challenge due to limited local availability of skin for closure and constant exposure to fecal contaminants. This report describes temporary rectal stenting in two dogs following severe perineal wounds. Dog 1 presented with a 4 × 4 cm full-thickness perineal slough secondary to multiple rectal perforations. A 12 mm internal diameter endotracheal tube was placed per-rectum as a temporary stent to minimize fecal contamination. The stent was removed 18 days after placement, and the perineal wound had healed at 32 days post-stent placement, when a minor rectal stricture associated with mild, intermittent tenesmus was detected. Long-term outcome was deemed good. Dog 2 presented with multiple necrotic wounds with myiasis, circumferentially surrounding the anus and extending along the tail. A 14 mm internal diameter endotracheal tube was placed per-rectum. The perineal and tail wounds were managed with surgical debridement and wet-to-dry and honey dressings prior to caudectomy and negative pressure wound therapy (NPWT). Delayed secondary wound closure and stent removal were performed on day six without complication. Long-term outcome was deemed excellent. Temporary rectal stenting may be a useful technique for fecal diversion to facilitate resolution of complex perineal injuries, including rectal perforation.
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Affiliation(s)
- Owen T Skinner
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida (O.T.S., G.W.E.); Joint Base Lewis-McChord Veterinary Center, Tacoma, Washington (J.G.C.); Department of Surgery, Section of Veterinary Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland (L.C.C.); and Oakland Veterinary Referral Services, Bloomfield Hills, Michigan (J.L.C.)
| | - Laura C Cuddy
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida (O.T.S., G.W.E.); Joint Base Lewis-McChord Veterinary Center, Tacoma, Washington (J.G.C.); Department of Surgery, Section of Veterinary Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland (L.C.C.); and Oakland Veterinary Referral Services, Bloomfield Hills, Michigan (J.L.C.)
| | - James G Coisman
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida (O.T.S., G.W.E.); Joint Base Lewis-McChord Veterinary Center, Tacoma, Washington (J.G.C.); Department of Surgery, Section of Veterinary Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland (L.C.C.); and Oakland Veterinary Referral Services, Bloomfield Hills, Michigan (J.L.C.)
| | - Jennifer L Covey
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida (O.T.S., G.W.E.); Joint Base Lewis-McChord Veterinary Center, Tacoma, Washington (J.G.C.); Department of Surgery, Section of Veterinary Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland (L.C.C.); and Oakland Veterinary Referral Services, Bloomfield Hills, Michigan (J.L.C.)
| | - Gary W Ellison
- From the Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida (O.T.S., G.W.E.); Joint Base Lewis-McChord Veterinary Center, Tacoma, Washington (J.G.C.); Department of Surgery, Section of Veterinary Clinical Studies, School of Veterinary Medicine, University College Dublin, Dublin, Ireland (L.C.C.); and Oakland Veterinary Referral Services, Bloomfield Hills, Michigan (J.L.C.)
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17
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Petrone P, Rodríguez Velandia W, Dziaková J, Marini CP. Treatment of complex perineal trauma. A review of the literature. Cir Esp 2016; 94:313-22. [PMID: 26895924 DOI: 10.1016/j.ciresp.2015.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Revised: 10/29/2015] [Accepted: 11/25/2015] [Indexed: 11/18/2022]
Abstract
Perineal injuries are uncommon, but not rare. They may present a wide variety of injury patterns which demand an accurate diagnostic assessment and treatment. Perineal injuries may occur as isolated injuries to the soft tissues or may be associated with pelvic organ, abdominal or even lower extremity injury. Hence the importance to know in depth not only the anatomy of the perineum and its organs, but also the implications of the patient's hemodynamic stability on the decision making process when treating these injuries using established trauma guidelines. The purpose of this review is to describe the current epidemiology and clinical presentation of perineal injuries in order to provide specific guidelines for the diagnosis and treatment of both stable and unstable patients.
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Affiliation(s)
- Patrizio Petrone
- Department of Surgery, Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU..
| | - Wilson Rodríguez Velandia
- Department of Surgery, Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
| | - Jana Dziaková
- Department of Surgery, Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
| | - Corrado P Marini
- Department of Surgery, Division of Trauma Surgery, Surgical Critical Care & Acute Care Surgery, New York Medical College, Westchester Medical Center University Hospital, Valhalla, Nueva York, EE. UU
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18
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Le A, Wang Z, Shan L, Xiao T, Zhuo R, Luo G. Peritoneal vaginoplasty by Luohu I and Luohu II technique: a comparative study of the outcomes. Eur J Med Res 2015; 20:69. [PMID: 26297245 PMCID: PMC4546317 DOI: 10.1186/s40001-015-0165-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Surgical vaginoplasty is the standard treatment for women suffering from Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. This study compares the advantages and disadvantages of Luohu I technique or its modification, Luohu II technique. METHODS Women with MRKH syndrome undergoing laparoscopic peritoneal vaginoplasty using either the Luohu I (N = 145) or Luohu II (N = 155) technique were recruited. We compare the effectiveness of the Luohu II and one of Luohu I. Sexual satisfaction was checked by Female Sexual Function Index. RESULTS There was no significant difference in the mean operation time, volume of intraoperative blood loss, time for the first passage of gas, sexual satisfaction (and hospital stay for patients in either group (P > 0.05). But patients in the Luohu II group had a significantly lower incidence of complications than patients in the Luohu I group. All patients had vaginal depths more than 9 cm over 3 months post-surgery. CONCLUSIONS Compared with the traditional Luohu I laparoscopic peritoneal vaginoplasty, the Luohu II operation is easier to perform and causes less damage to the bladder and rectum. The physiological and anatomical features of the artificial vagina resemble the normal vagina in both techniques.
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Affiliation(s)
- Aiwen Le
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
| | - Zhonghai Wang
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China.
| | - Lili Shan
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
| | - Tianhui Xiao
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
| | - Rong Zhuo
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Nanshan People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
| | - Guangnan Luo
- Department of Obstetrics and Gynecology, Affiliated Shenzhen Luohu People's Hospital of Guaongdong Medical University, Shenzhen, 518052, Guangdong, China
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19
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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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20
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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: 0.7] [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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21
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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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22
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Mazur MD, Duhon BS, Schmidt MH, Dailey AT. Rectal perforation after AxiaLIF instrumentation: case report and review of the literature. Spine J 2013; 13:e29-34. [PMID: 23981818 DOI: 10.1016/j.spinee.2013.06.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Revised: 03/22/2013] [Accepted: 06/14/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Bowel perforation is an uncommon complication of posterior spinal surgery. The AxiaLIF transsacral instrumentation system has been used for the treatment of L5-S1 spondylolisthesis and degenerative disc disease since its introduction in 2005 as a potentially less invasive alternative to traditional anterior or posterior interbody fusion. PURPOSE In this article, we report a case of a rectal perforation as a complication of placement of the AxiaLIF instrumentation system that was successfully treated without the removal of the device. STUDY DESIGN Case report. METHODS The patient presented with progressive back pain and sepsis 3 weeks after an L5-S1 fusion done with the AxiaLIF technique at an outside facility. The patient was managed with antibiotic therapy and a diverting ileostomy, without the removal of the AxiaLIF device. RESULTS Over the next year, she had symptoms indicative of nonunion of the operated level and breakdown at the adjacent level, which were confirmed with imaging. She underwent revision posterior spinal fusion without the removal of the AxiaLIF device. Eighteen months after the AxiaLIF device was placed, the patient continued to demonstrate no signs of infection recurrence. CONCLUSIONS Delayed presentation of rectal perforation with a subsequent anaerobic sepsis is a potential complication of the presacral approach to the L5-S1 disc space. Recognition and treatment with fecal diversion and long-term intravenous antibiotics is an alternative to device removal and sacral reconstruction.
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Affiliation(s)
- Marcus D Mazur
- Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, 175 N. Medical Dr. East, Salt Lake City, UT 84132, USA
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23
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Eliya‐Masamba MC, Banda GW, Cochrane Wounds Group. Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury. Cochrane Database Syst Rev 2013; 2013:CD008574. [PMID: 24146332 PMCID: PMC11994981 DOI: 10.1002/14651858.cd008574.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Acute traumatic wounds are one of the common reasons why people present to the emergency department. Primary closure has traditionally been reserved for traumatic wounds presenting within six hours of injury and considered 'clean' by the attending surgeon, with the rest undergoing delayed primary closure as a means of controlling wound infection. Primary closure has the potential benefit of rapid wound healing but poses the potential threat of increased wound infection. There is currently no evidence to guide clinical decision-making on the best timing for closure of traumatic wounds. OBJECTIVES To determine the effect on time to healing of primary closure versus delayed closure for non bite traumatic wounds presenting within 24 hours post injury. To explore the adverse effects of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours post injury. SEARCH METHODS In May 2013, for this first update we searched the Cochrane Wounds Group Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library); Ovid MEDLINE; Ovid MEDLINE (In-Process & Other Non-Indexed Citations); Ovid EMBASE; and EBSCO CINAHL. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials comparing primary closure with delayed closure of non bite traumatic wounds. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated the results of the searches against the inclusion criteria. No studies met the inclusion criteria for this review. MAIN RESULTS Since no studies met the inclusion criteria, neither a meta-analysis nor a narrative description of studies was possible. AUTHORS' CONCLUSIONS There is currently no systematic evidence to guide clinical decision-making regarding the timing for closure of traumatic wounds. There is a need for robust research to investigate the effect of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours of injury.
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Affiliation(s)
- Martha C Eliya‐Masamba
- John Hopkins Research Project ‐ Malawi College of MedicineQueen Elizabeth Central HospitalChipatala Avenue, P.O. Box 1131BlantyreMalawi
| | - Grace W Banda
- Ministry of HealthMulanje District Health OfficeP.O. Box 227MulanjeMalawi
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Ibn majdoub Hassani K, Ait laalim S, Benjelloun EB, Toughrai I, Mazaz K. Anorectal avulsion: an exceptional rectal trauma. World J Emerg Surg 2013; 8:40. [PMID: 24094142 PMCID: PMC3852814 DOI: 10.1186/1749-7922-8-40] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2013] [Accepted: 09/15/2013] [Indexed: 11/10/2022] Open
Abstract
Anorectal avulsion is an exceptional rectal trauma in which the anus and sphincter no longer join the perineum and are pulled upward. As a result, they ventrally follow levator ani muscles. We present a rare case of a 29-years old patient who was admitted in a pelvic trauma context; presenting a complete complex anorectal avulsion. The treatment included a primary repair of the rectum and a diverting colostomy so as to prevent sepsis. Closure of the protective sigmoidostomy was performed seven months after the accident and the evolution was marked by an anal stenosis requiring iterative dilatations.
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Affiliation(s)
- Karim Ibn majdoub Hassani
- Department of Surgery, School of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893; Km2.200, Route de Sidi Hrazem, Fez 30000, Morocco
| | - Said Ait laalim
- Department of Surgery, School of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893; Km2.200, Route de Sidi Hrazem, Fez 30000, Morocco
| | - El Bachir Benjelloun
- Department of Surgery, School of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893; Km2.200, Route de Sidi Hrazem, Fez 30000, Morocco
| | - Imane Toughrai
- Department of Surgery, School of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893; Km2.200, Route de Sidi Hrazem, Fez 30000, Morocco
| | - Khalid Mazaz
- Department of Surgery, School of Medicine and Pharmacy of Fez, Sidi Mohammed Ben Abdellah University, BP: 1893; Km2.200, Route de Sidi Hrazem, Fez 30000, Morocco
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25
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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: 10] [Impact Index Per Article: 0.8] [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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26
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Causey MW, Rivadeneira DE, Steele SR. Historical and current trends in colon trauma. Clin Colon Rectal Surg 2012; 25:189-99. [PMID: 24294119 PMCID: PMC3577616 DOI: 10.1055/s-0032-1329389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [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
| | - David E. Rivadeneira
- Department of Surgery, St. Catherine of Siena Medical Center, Smithtown, New York
| | - Scott R. Steele
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
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27
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Abstract
Rectal trauma is associated with high rates of morbidity and mortality and generally affects young males due to its aetiology of violent crime and vehicular collision. Historically, management has followed principles derived from military practice, with faecal diversion, pre-sacral drainage and distal washout being mandatory. Civilian trauma studies examining management of colon and rectum injuries from the early 1950s identified major differences in the level of energy transfer between civilian and military wounds, given that the vast majority are penetrating in nature. This led to a re-evaluation of the necessity for these interventions for all rectal injuries. Current management depends on whether the injury is intra- or extraperitoneal, with those above the peritoneal reflection being readily accessible and amenable to treatment as for colon injury. Extraperitoneal injuries remain difficult to access and direct repair is usually impossible; the mainstay of treatment in most instances remains faecal diversion. The role of pre-sacral drainage and distal washout remains contentious in the realms of civilian rectal injury but retains a place in battlefield or other high-energy transfer rectal injuries where aggressive early management reduces septic complications. This article reviews the historical and current evidence for the management of both civilian and military extraperitoneal rectal injuries.
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Affiliation(s)
- Sarah Barkley
- Department of Colorectal Surgery, Northern General Hospital, Sheffield, UK
| | - Mansoor Khan
- Department of General Surgery, Doncaster Royal Infirmary, Doncaster, UK
| | - Jeff Garner
- Rotherham NHS Foundation Trust and Academic Department of Military Surgery and Trauma, Royal Centre for Defence Medicine, Birmingham, UK
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Castrillon GA, Soto JA. Multidetector Computed Tomography of Penetrating Abdominal Trauma. Semin Roentgenol 2012; 47:371-6. [DOI: 10.1053/j.ro.2012.05.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Figler BD, Hoffler CE, Reisman W, Carney KJ, Moore T, Feliciano D, Master V. Multi-disciplinary update on pelvic fracture associated bladder and urethral injuries. Injury 2012; 43:1242-9. [PMID: 22592152 DOI: 10.1016/j.injury.2012.03.031] [Citation(s) in RCA: 59] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 03/08/2012] [Accepted: 03/31/2012] [Indexed: 02/02/2023]
Abstract
Pelvic ring fractures often result in severely injured patients with multiple organ injuries. The most common associated injuries are intraabdominal or urogenital, and urogenital injuries are the most common associated injuries in those with severe pelvic fractures. Prompt and effective diagnosis and management of these injuries is essential to successful outcomes, but this is potentially complicated by poor communication and coordination among the many specialists involved. To address this, we present a multi-disciplinary review of pelvic fracture-associated bladder and urethral injuries that is specifically geared towards orthopaedic, urology, and trauma surgeons caring for these patients.
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Affiliation(s)
- Bradley D Figler
- Department of Urology, University of Washington and Harborview Medical Center, Box 359868, 325 9th Avenue, Seattle, WA 98104, USA.
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Rispoli C, Andreuccetti J, Iannone L, Armellino M, Rispoli G. Anorectal avulsion: Management of a rare rectal trauma. Int J Surg Case Rep 2012; 3:319-21. [PMID: 22554940 DOI: 10.1016/j.ijscr.2012.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2012] [Revised: 03/13/2012] [Accepted: 04/01/2012] [Indexed: 10/28/2022] Open
Abstract
INTRODUCTION Traumatic injuries of the rectum are unusual even though their treatment is challenging and often lead to high morbidity and mortality rate. PRESENTATION OF CASE This paper reports a rare case of complete rectal avulsion with multiple fracture and hemoperitoneum treated with a multistep approach in our department. DISCUSSION The anorectal avulsion is a rare rectal trauma; only few reports are available. Treatment key points of rectal trauma are: direct repair, diverting stoma and sacral drainage. CONCLUSION We reported a case of anorectal avulsion with complete detachment of external sphincter muscle. A multidisciplinary approach was mandatory in this kind of lesions.
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Affiliation(s)
- C Rispoli
- Department of General Surgery, Ascalesi Hospital - ASL NA1, Naples, Italy
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31
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LeBedis CA, Anderson SW, Soto JA. CT imaging of blunt traumatic bowel and mesenteric injuries. Radiol Clin North Am 2012; 50:123-36. [PMID: 22099491 DOI: 10.1016/j.rcl.2011.08.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Delayed diagnosis of a bowel or mesenteric injury resulting in hollow viscus perforation leads to significant morbidity and mortality from hemorrhage, peritonitis, or abdominal sepsis. The timely diagnosis of bowel and mesenteric injuries requiring operative repair depends almost exclusively on their early detection by the radiologist on computed tomography examination, because the clinical signs and symptoms of these injuries are not specific and usually develop late. Therefore, the radiologist must be familiar with the often-subtle imaging findings of bowel and mesenteric injury that will allow for appropriate triage of a patient who has sustained blunt trauma to the abdomen or pelvis.
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Affiliation(s)
- Christina A LeBedis
- Department of Radiology, Boston University School of Medicine, MA 02118, USA
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Brady RR, O'Neill S, Berry O, Kerssens JJ, Yalamarthi S, Parks RW. Traumatic injury to the colon and rectum in Scotland: demographics and outcome. Colorectal Dis 2012; 14:e16-22. [PMID: 21831191 DOI: 10.1111/j.1463-1318.2011.02753.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
AIM An analysis of a multi-centred database of trauma patients was performed. METHOD The study used data from a prospective multi-centre trauma database containing details of 52 887 trauma patients admitted to participating Scottish Hospitals over an 11-year period. RESULTS Three hundred and forty (0.64%) of 52 887 trauma patients (284 male) with colorectal injuries were identified; 43.9% of colorectal injuries occurred following blunt trauma and 56.1% following penetrating injury. Patients in the latter group were younger, had less haemodynamic compromise and were less likely to die than those with blunt trauma (P < 0.01). The overall mortality rate was 25.6% and after rectal injury it was 21.2% (P > 0.05). Female gender, increased age, road traffic accidents and those admitted as a result of a blunt traumatic injury were associated with increased mortality. Age > 65 years (P = 0.01), increasing injury severity score (ISS) at presentation (P < 0.001), haemodynamic compromise (P = 0.045) and decreased Glasgow Coma Score (GCS) (P < 0.001) had the strongest independent associations with mortality. CONCLUSION Colorectal injury after trauma has a high morbidity. Clinical features associated with death allow stratification of mortality risk.
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Affiliation(s)
- R R Brady
- Department of Surgery, Queen Margaret Hospital, NHS Fife, Scotland, UK.
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Gümüş M, Böyük A, Kapan M, Onder A, Taskesen F, Aliosmanoğlu İ, Tüfek A, Aldemir M. Unusual extraperitoneal rectal injuries: a retrospective study. Eur J Trauma Emerg Surg 2011; 38:295-9. [DOI: 10.1007/s00068-011-0163-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2011] [Accepted: 10/22/2011] [Indexed: 11/29/2022]
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Traumatismo intestinal y mesentérico. RADIOLOGIA 2011; 53 Suppl 1:51-9. [DOI: 10.1016/j.rx.2011.06.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2011] [Revised: 06/22/2011] [Accepted: 06/24/2011] [Indexed: 11/20/2022]
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Bonnard A, Paye-Jaouen A, Ilharborde B, Brasher C, Aizenfisz S, Sebag G, El Ghoneimi A. Lessons learnt from two pediatric motor vehicle accidents resulting in anal canal, rectal and gluteal muscle wrenching. Pediatr Surg Int 2011; 27:1135-9. [PMID: 21437699 DOI: 10.1007/s00383-011-2887-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/08/2011] [Indexed: 10/18/2022]
Abstract
Ano-rectal trauma is common in motor vehicle accidents involving children. Inadequate initial assessment of the extent of lesions may be life threatening. We describe two cases where children were struck by buses that subsequently rolled over them in the prone position, resulting in ano-rectal and gluteal muscle wrenching. The first patient was inadequately assessed. Initial management did not include a diverting stoma, leading to life-threatening necrosis and septic shock. The second benefitted from our previous experience and recovery was uneventful. The distinctive mechanism of trauma in true gluteal muscle and anal canal wrenching is discussed. Gluteal muscle, anal canal and rectal wrenching as a result of rolling force from a motor vehicle is a very serious condition requiring immediate intestinal diversion with a stoma. Immediate repair may be attempted at the same time as stoma creation if the patient is stable. Broad-spectrum antibiotics and close wound monitoring are necessary to avoid muscle necrosis and serious complications.
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Affiliation(s)
- A Bonnard
- Department of General and Urology Pediatric Surgery, Paris VII University, Robert Debré Hospital, APHP, 48, boulevard Sérurier, 75019, Paris, France.
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Eliya MC, Banda GW. Primary closure versus delayed closure for non bite traumatic wounds within 24 hours post injury. Cochrane Database Syst Rev 2011:CD008574. [PMID: 21901725 DOI: 10.1002/14651858.cd008574.pub2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Acute traumatic wounds are one of the common reasons why people present to the emergency department. Primary closure has traditionally been reserved for traumatic wounds presenting within six hours of injury and considered 'clean' by the attending surgeon, with the rest undergoing delayed primary closure as a means of controlling wound infection. Primary closure has the potential benefit of rapid wound healing but poses the potential threat of increased wound infection. There is currently no evidence to guide clinical decision-making on the best timing for closure of traumatic wounds. OBJECTIVES To determine the effect on time to healing of primary closure versus delayed closure for non bite traumatic wounds presenting within 24 hours post injury. To explore the adverse effects of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours post injury. SEARCH STRATEGY We searched the Cochrane Wounds Group Specialised Register (searched 14 July 2011); the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 3); Ovid MEDLINE (1950 to July Week 1 2011); Ovid MEDLINE (In-Process & Other Non-Indexed Citations, July 13, 2011); Ovid EMBASE (1980 to 2011 Week 27); and EBSCO CINAHL (1982 to 14 July 2011). There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA Randomised controlled trials comparing primary closure with delayed closure of non bite traumatic wounds. DATA COLLECTION AND ANALYSIS Two review authors independently evaluated the results of the searches against the inclusion criteria. No studies met the inclusion criteria for this review. MAIN RESULTS Since no studies met the inclusion criteria, neither a meta-analysis nor a narrative description of studies was possible. AUTHORS' CONCLUSIONS There is currently no systematic evidence to guide clinical decision-making regarding the timing for closure of traumatic wounds. There is a need for robust research to investigate the effect of primary closure compared with delayed closure for non bite traumatic wounds presenting within 24 hours of injury.
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Affiliation(s)
- Martha C Eliya
- John Hopkins Research Project - Malawi College of Medicine, Queen Elizabeth Central Hospital, Chipatala Avenue, P.O. Box 1131, Blantyre, Malawi
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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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Severe hemoperitoneum after patient self-induced fecal evacuation. Case Rep Med 2011; 2011:313841. [PMID: 21876699 PMCID: PMC3162978 DOI: 10.1155/2011/313841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Accepted: 07/04/2011] [Indexed: 11/30/2022] Open
Abstract
An increasing incidence of rectal injuries following patient self-induced harmful acts, aimed to sexual or laxatives porpouses, is a fact reported in literature (El-Ashaal et al., 2008). We herein report a case of severe hemoperitoneum related to a middle and upper rectal third seromuscolar tear caused by a self-induced fecal evacuation by means of an arrow with a covered cork tip. An urgent intestinal diversion by means of a Hartmann's operation was performed. The clinical case is presented in relation to the literature debate, regarding the issue of primary repair or resection and anastomosis versus fecal diversion for penetrating rectal injuries (Fabian, 2002; Cleary et al., 2006; Office of the Surgeon General, 1943; Busic et al., 2002). In conclusion, the importance of avoiding an anastomotic breakdown in a patient undergoing a hemorrhagic shock is highlighted.
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Abstract
STUDY DESIGN Case report. OBJECTIVE To report an extremely rare case of combined penetrating injury to rectum and vertebral body by steel bar causing cauda equina syndrome. SUMMARY OF BACKGROUND DATA Only one similar case has been reported. Our case was more severe and posed more challenges to physicians. METHODS A 37-year-old male had a penetrating rectal injury by a long steel bar as a result of a falling accident. He was firstly treated with removal of the bar, debridement, and fecal diversion. Spine and cauda equina injuries were found the second day by lumbar and sacral CT. Because of infection after the first surgery, decompressive surgery was performed 2 months from injury. Cerebrospinal fluid fistula happened on the 12th day after surgery which was managed by debridement, irrigation and drainage, suture of the leaking skin and combined use of antibiotics. RESULTS When being discharged, he could ambulate independently but could not control his voiding. The colostomy and urinary canal was preserved during the follow-up. CONCLUSION Steel bar penetrating injury of rectum and vertebral body can be severe and cause complex injuries. Complications included infection and cerebrospinal fluid fistula. Thorough history and physical examination and CT and MRI inspection are very important for timely diagnosis and early treatment of spine and cauda equina injuries. Dural tear should be carefully inspected and repaired during posterior lumbar decompression surgery. Cooperation of experienced surgeons from orthopedics and gastrointestinal department is needed to give the patient the most appropriate treatment and improve prognosis.
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Abstract
The current dogma about the treatment of penetrating colon injuries is reviewed, both from the civilian and the military perspective. This discussion is still evolving, and the time-honored methods of diversion, including colostomy and ileostomy, are still appropriate for the most severe and devastating sorts of wounds, especially in the military context. For the vast majority of penetrating wounds, primary repair works well and should be practiced. For the few patients who have primary repair that fails and leaks, mortality rates are high. The art of surgery involves knowing when to divert and when to repair.
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Affiliation(s)
- David R Welling
- Surgery and Anatomy, Uniformed Services University, Bethesda, MD 20814-4799, USA.
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Govender M, Madiba TE. Current management of large bowel injuries and factors influencing outcome. Injury 2010; 41:58-63. [PMID: 19535065 DOI: 10.1016/j.injury.2009.01.128] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2008] [Revised: 01/06/2009] [Accepted: 01/19/2009] [Indexed: 02/02/2023]
Abstract
BACKGROUND Colonic and intra-peritoneal rectal injuries may be managed by primary repair and extra-peritoneal rectal injuries by diverting colostomy. This study was undertaken to document our experience with this approach and to identify factors which might impact on outcome. PATIENTS AND METHODS Prospective study of all patients treated for colon and rectal injuries in one surgical ward at King Edward VIII hospital, Durban, over a 7-year period (1998-2004). Demographic data, clinical presentation, findings at laparotomy and outcome were documented. RESULTS Of 488 patients undergoing laparotomy, 177 (36%) had injuries to the colon and rectum with age 29.8+/-10.9 years. Injury mechanisms were firearms (118) stabs (54) and blunt trauma (5). Delay before laparotomy was 10+/-9.3 h. Complication and mortality rates were 36% and 17%, respectively. 68 patients (38%) required ICU management. Shock on admission and increased transfusion requirements were associated with a significantly increased mortality. Patients with delay < or = 12 h before laparotomy had a higher mortality rate than those with delay >12 h. The mortality rate increased with the number of associated injuries and it was higher the higher the Injury Severity Score (ISS); it was similar for stabs, firearms and blunt trauma. Hospital stay was 9.5+/-9.2 days. CONCLUSION We reaffirm that primary repair is appropriate for colonic and intra-peritoneal rectal injuries and that extra-peritoneal rectal injuries require diverting colostomy. Shock on admission, increased blood transfusion requirements, associated organ injury and severity of the injury were associated with high mortality.
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Affiliation(s)
- M Govender
- Department of Surgery, University of KwaZulu-Natal and King Edward VIII Hospital, Durban, South Africa
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Gür AS, Atahan K, Tarcan E, Durak E, Çökmez A, Küpeli H. Independent Predictors of Treatment Modality for Penetrating Colon Injury. Eur J Trauma Emerg Surg 2009; 35:378. [PMID: 26815053 DOI: 10.1007/s00068-008-8116-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2008] [Accepted: 09/22/2008] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND AIMS We aimed to evaluate the independent factors of the treatment of penetrating colon injuries in a teaching and research hospital in light of some of the most commonly cited considerations affecting the decision as to whether to perform primary repair or divert. METHODS Hospital records of patients between January 2004 and January 2007 were reviewed retrospectively. Fifty-seven patients were included and divided into two groups. Group A consisted of patients (n = 43) who had primary repair or resection and anastomosis, and Group B consisted of patients (n = 14) who had diverting colostomy. The degree of fecal contamination was assessed by reviewing the detailed operative dictation. The type of colon injury, as determined from the colon injury scale (CIS) of the American Association for the Surgery of Trauma (AAST), and the penetrating abdominal trauma index (PATI) were recorded. RESULTS Age, sex, presence of shock on admission, location of the injury, and colon-related or non-colonrelated complications between the two groups were not significant. Stab or gunshot injury, operation time, degree of fecal contamination (grade 1/2/3), transfusion, PATI score, hospital stay, and associated organ injury were significantly different in the two groups (p < 0.05). CONCLUSION Despite the fact that CIS, fecal contamination, transfusion, PATI and delayed operation affect the decision about the procedure, primary repair can be performed safely on patients with penetrating colon injuries.
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Affiliation(s)
- Akif S Gür
- , 124. sok No4/18 Evka3 Bornova, 35050, Izmir, Turkey.
| | | | | | | | | | - Hakan Küpeli
- 1st Surgical Department, Izmir Atatürk Teaching and Research Hospital, Izmir, Turkey
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Outcomes of Primary Repair and Primary Anastomosis in War-Related Colon Injuries. ACTA ACUST UNITED AC 2009; 66:1286-91; discussion 1291-3. [DOI: 10.1097/ta.0b013e31819ea3fc] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
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Bondia JM, Anderson SW, Rhea JT, Soto JA. Imaging colorectal trauma using 64-MDCT technology. Emerg Radiol 2009; 16:433-40. [DOI: 10.1007/s10140-009-0810-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2009] [Accepted: 03/27/2009] [Indexed: 10/20/2022]
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Petrone P, Inaba K, Wasserberg N, Teixeira PGR, Sarkisyan G, Dubose JJ, Fernandez MA, Peña FR, Rodriguez MA, Ortega AE, Kaufman HS. Perineal Injuries at a Large Urban Trauma Center: Injury Patterns and Outcomes. Am Surg 2009. [DOI: 10.1177/000313480907500410] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The purpose of this study was to describe the characteristics of this unique patient population, their clinical presentations, and outcomes. The Los Angeles County and University of Southern California Medical Center Trauma Registry was used to retrospectively identify patients who sustained perineal injuries. Information included gender, age, vital signs, trauma scores, mechanisms of injury, studies performed, surgeries performed, and outcomes. Pediatric patients and injuries related to obstetric trauma were not included. Sixty-nine patients were identified between February 1, 1992 and October 31, 2005. One patient died on arrival; 85 per cent (58 of 68) were males, mean age was 30 ± 12 years, and there was a penetrating mechanism in 56 per cent. Vital signs on admission were systolic blood pressure 119 ± 33 mmHg, heart rate 94 ± 27 beats/minute, and respiratory rate 20 ± 6 breaths/min. Glasgow Coma Scale (GCS) was 13 ± 3, Revised Trauma Score (RTS) was 7.2 ± 1.5, and Injury Severity Score (ISS) was 11 ± 12. CT scan was obtained for 23 (33%) patients. Lower extremity fractures were 35 per cent and pelvic fractures 32 per cent. The most common surgery was debridement and drainage, diversion with colostomy in five patients (7%). Overall mortality was 10 per cent. Mortality group mean scores were: GCS, 6; RTS, 5.74; and ISS, 34. The survival group mean scores were: GCS, 14; RTS, 7.7; and ISS, 8. There was a statistically significant association between mortality and GCS, RTS, and ISS scores ( P < 0.001). Most patients with perineal injuries (93%) can be managed without colostomy. Associated injuries are not uncommon, particularly bony fractures. Mortality is mostly the result of exsanguination related to associated injuries.
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Affiliation(s)
- Patrizio Petrone
- Division of Colorectal & Pelvic Floor Surgery and the, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Kenji Inaba
- Division of Trauma & Surgical Critical Care, Department of Surgery, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Nir Wasserberg
- Division of Colorectal & Pelvic Floor Surgery and the, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Pedro G. R. Teixeira
- Division of Trauma & Surgical Critical Care, Department of Surgery, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Grant Sarkisyan
- Division of Colorectal & Pelvic Floor Surgery and the, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Joseph J. Dubose
- Division of Trauma & Surgical Critical Care, Department of Surgery, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Maura A. Fernandez
- Division of Colorectal & Pelvic Floor Surgery and the, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Frida R. Peña
- Division of Colorectal & Pelvic Floor Surgery and the, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Margarita A. Rodriguez
- Division of Colorectal & Pelvic Floor Surgery and the, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Adrian E. Ortega
- Division of Colorectal & Pelvic Floor Surgery and the, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
| | - Howard S. Kaufman
- Division of Colorectal & Pelvic Floor Surgery and the, University of Southern California, Keck School of Medicine and Los Angeles County Medical Center, Los Angeles, California
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Anderson SW, Soto JA. Anorectal trauma: the use of computed tomography scan in diagnosis. Semin Ultrasound CT MR 2009; 29:472-82. [PMID: 19166043 DOI: 10.1053/j.sult.2008.10.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Anorectal injuries represent a relatively uncommon but clinically critical diagnosis in trauma. Anorectal injuries may be the result of penetrating injuries to the pelvis and perineal area as well as severe blunt traumatic injuries, often with pelvic fractures. The purpose of this review is to discuss injuries to the anorectal region sustained in trauma, specifically, in the application of multidetector computed tomography technology to these imaging diagnoses. An understanding of the pertinent anatomy is critical in characterization of these injuries using computed tomography (CT). Additionally, the subsequent clinical management decisions and how they are impacted by severity and location of injury in anorectal trauma is useful to the radiologist. This should serve to highlight the specific areas and injury distinctions that deserve our particular attention given possible changes in the ensuing management approaches. CT protocol issues including the use of oral, rectal, and intravenous contrast, as necessary, are relevant in maximizing the diagnostic accuracies of CT in anorectal trauma. This review serves to discuss and illustrate these pertinent issues, approaching penetrating and blunt trauma separately, with the emphasis on multidetector computed tomography in diagnosis.
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Affiliation(s)
- Stephan W Anderson
- Department of Radiology, Boston University Medical Center, Boston, MA, USA.
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Roig JV, García-Armengol J, Alós R, Solana A, Rodríguez-Carrillo R, Galindo P, Fabra MI, López-Delgado A, García-Romero J. Preparar el colon para la cirugía. ¿Necesidad real o nada más (y nada menos) que el peso de la tradición? Cir Esp 2007; 81:240-6. [PMID: 17498451 DOI: 10.1016/s0009-739x(07)71312-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Mechanical bowel preparation is a traditional procedure for preparing patients for colorectal surgery. This practice aims to reduce the risk of postoperative infectious complications since colonic fecal content has classically been related to stool spillage during surgery and anastomotic disruption. However, increasing evidence against its routine use can be found in experimental studies, clinical observations, prospective studies, and meta-analyses. We performed a review of the literature on mechanical bowel preparation and its consequences. There is no clear evidence that preoperative bowel cleansing reduces the septic complications of surgery and routine use of this procedure may increase anastomotic leaks and morbidity. Therefore, the results suggest that mechanical preparation is not required in elective colon and rectal surgery and that its use should be restricted to specific indications such as small nonpalpable tumors to aid their localization during laparoscopic procedures or to enable intraoperative colonoscopy. The role of mechanical bowel preparation in rectal surgery is not well defined and further trials with a larger number of patients are required.
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Affiliation(s)
- José V Roig
- Servicio de Cirugía General y Digestiva, Consorcio Hospital General Universitario de Valencia, Valencia, España.
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Abstract
AIM: To retrospectively evaluate the preoperative diagnostic approaches and management of colonic injuries following blunt abdominal trauma.
METHODS: A total of 82 patients with colonic injuries caused by blunt trauma between January 1992 and December 2005 were enrolled. Data were collected on clinical presentation, investigations, diagnostic methods, associated injuries, and operative management. Colonic injury-related mortality and abdominal complications were analyzed.
RESULTS: Colonic injuries were caused mainly by motor vehicle accidents. Of the 82 patients, 58 (70.3%) had other associated injuries. Laparotomy was performed within 6 h after injury in 69 cases (84.1%), laparoscopy in 3 because of haemodynamic instability. The most commonly injured site was located in the transverse colon. The mean colon injury scale score was 2.8. The degree of faecal contamination was classified as mild in 18 (22.0%), moderate in 42 (51.2%), severe in 14 (17.1%), and unknown in 8 (9.8%) cases. Sixty-seven patients (81.7%) were treated with primary repair or resection and anastomosis. Faecal stream diversion was performed in 15 cases (18.3%). The overall mortality rate was 6.1%. The incidence of colonic injury-related abdominal complications was 20.7%. The only independent predictor of complications was the degree of peritoneal faecal contamination (P = 0.02).
CONCLUSION: Colonic injuries following blunt trauma are especially important because of the severity and complexity of associated injuries. A thorough physical examination and a combination of tests can be used to evaluate the indications for laparotomy. One stage management at the time of initial exploration is most often used for colonic injuries.
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Affiliation(s)
- Yi-Xiong Zheng
- Department of Surgery, Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, Zhejiang Province, China.
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