Colon Trauma Research Articles

Impact of Concomitant Traumatic Pancreatic and Colon Injuries on Outcomes.

Colon and pancreatic injuries have both long been independently associated with intraabdominal infectious complications in trauma patients. The goal of this study was to evaluate the impact of concomitant pancreatic injury on outcomes in patients with traumatic colon injuries. Consecutive patients over a 3-year period who underwent operative management of colon injuries were identified. Patient characteristics, severity of injury and shock, presence and grade of pancreatic injury, and intraoperative packed red blood cell (PRBC) transfusions were recorded. Outcomes including intraabdominal abscess formation and suture line failure were collected and compared. Multivariable logistic regression analysis was then performed to determine the impact of concomitant pancreatic injury on intraabdominal abscess formation. 243 patients with traumatic colon injuries were identified. 17 of these also had pancreatic injuries. Patients with combined colon and pancreatic injuries were clinically similar to those with isolated colon injuries with respect to age, gender, penetrating mechanism of injury, admission lactate, ISS, suture line failure, and admission systolic blood pressure. Both intraabdominal abscess rates (88.2% vs 29.6%, P < .001) and intraoperative PRBC transfusions (8 vs 1 units, P = .004) were higher in the combined pancreatic and colon injury group. Multivariable logistic regression identified both intraoperative PRBC transfusions (odds ratio, 1.09; 95% confidence interval, 1.04-1.15; P < .001) and concomitant pancreatic injury (odds ratio, 14.8; 95% confidence interval, 3.92-96.87; P < .001) as independent predictors of intraabdominal abscess formation. Both intraoperative PRBC transfusions and presence of concomitant pancreatic injury are independent predictors of intraabdominal abscess formation in patients with traumatic colon injuries.

Inventing Traditions in Minority Nationalisms: Political Sovereignty and Historical Trauma in the Iroquois Nationalist Imagination

The author analyzes the characteristics of the invention of traditions in modern Iroquois nationalism, a minority nationalist movement in the United States. The study examines the invention of traditions within the methodological frameworks of modern interdisciplinary historiography, particularly focusing on interventionist and imaginative turns, which are integral to analyzing minority nationalism. The author suggests that: 1) most traditions invented in modern Iroquois nationalism are political; 2) the concepts of “statehood” and “sovereignty” are central to the functioning of these political traditions; 3) the invention of traditions underscores the historical trauma of colonization and the institutionalization of the Iroquois’ unequal status as a minority group; 4) reproducing these invented traditions in political discourse is an effort to revitalize Iroquois identity; 5) the invented traditions of Iroquois nationalism serve a compensatory purpose, aiming to overcome the collective historical trauma of losing their political state tradition. Overall, the author suggests that the development of Iroquois nationalism hinges on the invention of traditions, which Native American ethnic and political activists actively use to consolidate Iroquois identity in the United States.

Naeseon Ilche and Nazi medievalism: making nation, history, and film

ABSTRACT The present study aims to compare the cinematic propaganda of colonial Korea and Nazi Germany, revealing how the two countries used film to construct narratives of nationalism. Furthermore, this study will aid our recognition and understanding of the similarities and differences between victims and aggressors in spreading nationalist propaganda. Despite the similarities between the colonial Korean and Nazi German film industries in spreading nationalist propaganda, there are significant differences between these two countries’ ways of promoting national values: the colonial Koreans adopted transcolonial nationhood (i.e. the strategy of integrating nations), whereas the Nazis excluded minorities, such as Jews. Therefore, dichotomous evaluations of the victim and the aggressor are inconsistent with existing standard interpretations. Colonial Korea, generally known as having experienced the trauma of colonization, also engaged in cinematic fabrication and the weaponization of history, as Nazi Germany did. Propaganda films in both colonial Korea and Nazi Germany played a significant role in reconstructing their national identities. Regarding the cinematic reinvention of these national identities, we should eschew the artificial dichotomy between victims and aggressors.

Primary Repair Versus Resection for AAST Grade I and II Colon Injuries: Does the Type of Repair Matter?

IntroductionThe management of traumatic colon injuries has evolved over the past two decades. Recent evidence suggests that primary repair or resection over colostomy may decrease morbidity and mortality. Data comparing patients undergoing primary repair versus resection are lacking. We sought to compare the outcomes of patients undergoing primary repair versus resection for low-grade colon injuries. MethodsA retrospective review of all patients who presented with American Association for the Surgery of Trauma grade I and II traumatic colon injuries to our Level I trauma center between 2011 and 2021 was performed. Patients were further dichotomized based on whether they underwent primary repair or resection with anastomosis. Outcome measures included length of stay data, infectious complications, and mortality. ResultsA total of 120 patients met inclusion criteria. The majority of patients (76.7%) were male, and the average age was 35.6 ± 13.1 y. Most patients also underwent primary repair (80.8%). There were no statistically significant differences between the groups in arrival physiology or in injury severity score. Length of stay data including hospital length of stay, intensive care unit length of stay, and ventilator days were similar between groups. Postoperative complications including pneumonia, surgical site infections, fascial dehiscence, the development of enterocutaneous fistulas, and unplanned returns to the operating room were also all found to be similar between groups. The group who underwent resection with anastomosis did demonstrate a higher rate of intra-abdominal abscess development (3.1% versus 26.1%, P < 0001). Mortality between both groups was not found to be statistically significant (7.2% versus 4.3%, P = 0.4) ConclusionsFor low-grade (American Association for the Surgery of Trauma I and II) traumatic colon injuries, patients undergoing primary repair demonstrated a decreased rate of intra-abdominal abscess development when compared to patients who underwent resection with anastomosis.

Melatonin supplementation protects against traumatic colon injury by regulating SERPINA3N protein expression.

Traumatic colon injury (TCI) is a typical injury with high mortality. Prolongation of the intervention time window is a potentially useful approach to improving the outcomes of TCI casualties. This study aimed to identify the pathological mechanisms of TCI and to develop effective strategies to extend the survival time. A semicircular incision was made to prepare a TCI model using C57BL/6 mice. An overview of microbiota dysregulation was achieved by metagenome sequencing. Protein expression reprogramming in the intestinal epithelium was investigated using proteomics profiling. The mice that were subjected to TCI died within a short period of time when not treated. Gut symbiosis showed abrupt turbulence, and specific pathogenic bacteria rapidly proliferated. The protein expression in the intestinal epithelium was also reprogrammed. Among the differentially expressed proteins, SERPINA3N was overexpressed after TCI modeling. Deletion of Serpina3n prolonged the posttraumatic survival time of mice with TCI by improving gut homeostasis in vivo. To promote the translational application of this research, the effects of melatonin (MLT), an oral inhibitor of the SERPINA3N protein, were further investigated. MLT effectively downregulated SERPINA3N expression and mitigated TCI-induced death by suppressing the NF-κB signaling pathway. Our findings prove that preventive administration of MLT serves as an effective regimen to prolong the posttraumatic survival time by restoring gut homeostasis perturbed by TCI. It may become a novel strategy for improving the prognosis of patients suffering from TCI.

Proximal protective diverting ostomy following colon anastomosis for penetrating trauma may not be protective: A matched cohort study

IntroductionDespite the shift toward liberal primary anastomosis in penetrating colon injuries, some surgeons recommend a protective diverting ostomy (DO) proximal to the anastomosis. This study evaluates the effect of DO on outcomes in patients undergoing colon resection and anastomosis following penetrating trauma. MethodsThe TQIP database (2013–2018) was queried for penetrating colon injuries undergoing colectomy and anastomosis. Patients receiving DO were propensity matched to patients without diverting ostomy (woDO) (1:3). Outcomes were compared between groups. ResultsAfter matching, 89 DO patients were analyzed. The DO group had more surgical site infections (32 ​% vs. 21 ​%; p ​< ​0.05) and longer hospital stay (20 [13–27] vs. 15 [9–25]; p ​< ​0.05) compared to the woDO group. Mortality and unplanned operations were similar between groups. ConclusionsDiverting ostomy after colon resection and anastomosis is associated with increased infectious complications without decreasing unplanned operations or mortality. Its routine role in penetrating colon trauma needs reassessment.

Evaluation of the predictive effects of trauma scoring systems in colorectal injuries.

Colorectal injuries following traumas are significant causes of morbidity and mortality. This study aimed to evaluate the predictive effect of trauma scoring systems on mortality and morbidity in patients with post-traumatic colon injury. The records of 145 patients with colon trauma treated at Seyhan State Hospital between January 1, 2010, and January 1, 2020, were retrospectively analyzed. Injury Seriousness Score (ISS), Revised Trauma Score (RTS), Trauma Injury Severity Score (TRISS), and Colon Injury Score (CIS) scores were calculated for all patients. The predictive effects of scoring systems on primary outcomes of surgical treatment, complication rates, mortality, and anastomotic leaks were evaluated. The mean age of the patients was 36.1 (SD ± 16.6), and the female/male ratio was 37/108. Anastomotic leakage occurred in 12 (8.2%) patients, and complications were observed in 57 (39.3%) patients. Seven (4.7%) patients died. A statistically significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. Increases in ISS and decreases in RTS and TRISS were associated with increased morbidity and mortality, but these relationships were not statistically significant. A significant relationship was observed between the increase in CIS and anastomotic leakage, morbidity, and mortality. The study suggests the need for a specific scoring system for evaluating the prognostic status in colon traumas, as ISS, RTS, and TRISS scores were not found to be significantly predictive of outcomes in this patient population.

October 1: Metaphorizing Nigeria’s Collective Trauma of Colonization

Analogies have been drawn between therapeutic recovery and decolonization. This will mean that one can interrogate psychological effects of trauma on cultures or nations that undergo or have undergone colonization. If decolonization is perceived a form of therapy, colonialism is adjudged potential trauma. This paper is interested in understanding how colonialism could potentially traumatize a nation or given culture. It equally explores decolonization as a form of therapy. It thus analyses the trauma of colonialism in Kunle Afolayan’s October 1 (2014). No scholarly work has been done on the analysis of colonial trauma in Nollywood film texts. This might be as a result of the paucity of film texts that speak to the theme. This paper is therefore interested in understanding how Nollywood ace filmmaker, Kunle Afolayan, uses his October 1 as a metaphor to mirror the traumatic effect of colonialism on Nigeria as a nation. It explores how the film’s major characters’ relations to their traumatic pasts provide insight to Nigeria’s social history. This study attempts to visualize in Afolayan’s characters, a Nigeria traumatized by colonialism. It further envisions the possible paths to Nigeria’s survival of colonial trauma in these characters’ chosen paths to recovery. Using psychoanalysis as framework, this qualitative analysis explores decolonization as therapeutic and contributes to decolonization discourses in African film studies.

Chrystal Ann Chemris. The Spanish Baroque and Latin American Literary Modernity: Writing in Constellation

Chrystal Ann Chemris. <i>The Spanish Baroque and Latin American Literary Modernity: Writing in Constellation</i>

Assessment Self-Care Knowledge of Patients with Colostomy

Background: Stoma can be performed as either an urgent situation or optional surgical technique for the treatment of a wide variety of conditions affecting the bowel. These conditions involve colon cancer, bowel obstructions, colon trauma, diverticulitis, bowel necrosis, and ulcerative colitis. This procedure is performed for one of two primary reasons: either to redirect the colon or to decompress the colon. Objectives: The aim of this study is to assess Self-Care Knowledge of Patients with Colostomy at Al Nasiriyah Teaching Hospital. Methodology: The study was conducted using a quasi-experimental technique. The number of participants in the sample is thirty. The researcher devised a questionnaire in assess patients' levels of self-care knowledge after they had had colostomies. This was done in order to achieve the objectives of the study. The researcher created a questionnaire format in order to meet the goals of the study. The study was carried out at Al Nasiriyah teaching hospital. Both intra examiner (test and retest) and inter examiner (alpha Cronbach) tests were used to validate the instrument's validity, and the reliability of the instrument was determined by utilizing intra examiner (test and retest) and inter examiner (alpha Cronbach) tests. The data was analyzed utilizing descriptive statistical data (frequency, percent, Mean of Score (MS), Variations among both pre / post Mean of Score, Standard Deviation (SD), and (RS percent) Relative Sufficiency), in addition to inferential analysis (Chi-Square test, and Contingency Coefficients (C.C.) test, t-test). Results: According to the results of the research, the patients' level of knowledge on colostomy was rather poor. Conclusion: According to the findings of this research, patients who had had colostomies did not have enough understanding about colostomy self-care. Recommendations: According to the findings of the research, patients who had colostomies should have attentive care in the form of consultations and telephone talks to help identify and manage any problems they may be experiencing. Establish instructional special units within surgical departments, particularly in colon operations, with experienced enter-stomal caregivers and all essential reference resources, such as technical manuals and multimedia components. These instructional special units should also be located within surgical departments.

Oral administration of asparagine and 3-indolepropionic acid prolongs survival time of rats with traumatic colon injury

BackgroundTraumatic colon injury (TCI) is a common disease during wartime. Prolongation of posttraumatic survival time is an effective approach to patient outcome improvement. However, there is a lack of basic research in this field. This study aimed to elucidate the mechanisms underlying TCI progression and to develop novel regimens to buy time for TCI patients on the battlefield.MethodsA total of 669 Sprague–Dawley rats were used in this study. Surgical colon incision was performed to generate the TCI rat model. The landscape of colon microbiota compositions was depicted using 16S rRNA sequencing and metabolites in the intestinal contents were detected by metabolomics profiling. The signaling transduction in the intestinal epithelium was investigated using antibody microarrays and Western blotting. The enzyme-linked immunosorbent assay was conducted to measure the levels of interleukin-6 and tumor necrosis factor-α in intestines and plasma for the detection of inflammatory responses. Diamine oxidase, D-lactate and endotoxin in plasma and protein expression of zonula occludens 1 and occludin were selected as the indicators of intestinal barrier permeability. To investigate alterations of microbiota symbiosis, the relative abundances of specific bacterial genera were detected using quantitative real-time PCR.ResultsAs a type of lethal injury, TCI induced acute disruption of intestinal homeostasis, characterized by inflammatory responses, intestinal barrier hyperpermeability and microbiota dysbiosis (P < 0.05). Significant alterations in bacterial metabolic patterns were detected with decreases in many metabolites. After a series of screenings, we found that oral administration of asparagine (Asn) and 3-indolepropionic acid (IPA) effectively prolonged posttraumatic survival time [Asn plus IPA vs. Vehicle: hazard ratio (HR) = 0.105, 95% CI 0.031–0.356, P = 0.0003] and restored intestinal homeostasis in TCI rats (P < 0.05). Mechanistically, this combinational strategy protected the rats against TCI through synergistic activation of Akt signaling in the intestinal epithelium (P < 0.05).ConclusionsAbrupt dysregulation of intestinal homeostasis plays a critical role in the progression toward TCI-induced death. Oral administration of Asn plus IPA may serve as an effective regimen to restore intestinal functions and prolong the posttraumatic survival time.

Emancipatory Methodologies: Knowledge Production and (Re)existence of the Misak People in Colombia

Indigenous communities such as the Misak people in Colombia continue to struggle against the consequences of colonization and violence, but at the same time, they propose emancipatory methodologies of knowledge production. These practices towards epistemic justice are crucial to assure the (re)existence of indigenous peoples and their wisdom in Abya Yala. In this vein, our article sheds light on research methodologies rooted in Misak cosmogonies and processes to validate ancestral knowledge production. Through ethnographic and participatory action research in the indigenous reserve of Shura Manéla in the Colombian Cauca Department, we got insight into the spiral of persistent existence (espiral de pervivencia) and the law of origin of the Misak people. On this basis, we describe the Latá-Latá methodology reinvented by the community to recover their ancestral knowledge, and the Pachakiwa social cartography applied to depict their territorial relations. Moreover, we explain how collective validation processes work in practice. This serves to open up a transdisciplinary discussion on the potentials and the limitations of such vernacular research methodologies. We observe that healing from the trauma of colonization and inferiorization is a key driver of indigenous research processes. Therefore, developing further emancipatory methodologies based on equal subject-subject relations is an urgent task in the field of decoloniality. Learning from communities like the Misak is an invitation to become aware of the pluriversal complexity, listen to silenced sagacity, and find methods to pursue epistemic equality.

Penetrating colon trauma - outcomes related to single versus multiple colonic injuries.

There is no conclusive evidence to guide surgical management in the presence of multiple colonic injuries as opposed to a single colonic injury, and whether multiple colonic suture lines are associated with worse outcomes than single suture lines. We reviewed the outcomes of penetrating colonic trauma in relation to whether patients had single versus multiple colonic suture lines (primary repair or anastomosis) following laparotomy. A retrospective study was conducted at a major trauma centre in South Africa from 2012-2020 for all patients over 18years who had sustained penetrating colon injury. 541 cases were included: 409 with single suture line and 54 with multiple suture lines. There were no differences between groups in terms of mechanism of injury (gunshot vs stab; p = 0.328), Injury Severity Score (p = 0.071), or Penetrating Abdominal Trauma Index (p = 0.396). Admission lactate was worse for multiple suture line patients (p = 0.049), but no other blood gas parameters were different, and there was no higher incidence of damage control surgery (p = 0.558) or ICU admission (p = 0.156) for this group. There was a higher rate of diversion in the multiple suture line group (p < 0.001). Univariable logistic regression did not show an increased risk of gastro-intestinal complications, suture line leak rate, or mortality for multiple suture lines compared to single. It appears that there is no appreciable difference in outcome between patients with a single colonic suture line compared to patients with more than one suture line following trauma laparotomy. In light of this, each injury should be treated on its own merit, in the context of the patient's overall physiological condition, without undue fear of leaving the patient with more than one colonic suture line. However, judicious use of diversion remains advisable.

Penetrating colon trauma-the effect of concomitant small bowel injury on outcome

IntroductionThere is limited evidence to suggest that patients with penetrating colon injury have higher complication rates when there is concomitant small bowel (SB) injury. AimWe performed a retrospective study looking at outcomes of penetrating colonic trauma in patients with- and without concomitant SB injury. MethodsWe interrogated our electronic registry over an eight-year period (2012–2020) for all patients over 18 years who had sustained penetrating colon injury and who had survived beyond 72 h. Demographic data, admission physiology, and Injury Severity Score (ISS) were recorded. Two groups of patients were observed: those with colonic injury (no SB injury) and those with combined colon and SB injury. Outcomes observed included leak rates, length of Intensive Care Unit (ICU) stay, length of hospital stay (LOS), morbidity and mortality. ResultsA total of 450 patients were eligible for analysis, of which 257 had colon injury without SB injury and 193 had a combination of colon and SB injury. There was no difference in mechanism of injury between groups. Admission physiology was similar between groups but arterial blood gas values were worse in the combined group. Rates of damage control surgery and ICU admission were higher in the combined group. Primary repair was done in equal proportions between groups but anastomosis was more frequently performed in the combined group. There was no difference in complication rates, including gastro-intestinal complications and suture line leaks. Length of ICU stay, LOS, and mortality were similar between groups. Univariable analysis demonstrated that the presence of concomitant small bowel injury was not an independent risk factor for colonic suture line failure or death. ConclusionThere is no evidence from this data that the presence of a combined penetrating colon and SB injury should change management priorities. Each injury should be treated on its own merit, in the context of the patient's physiology.

Penetrating Colon Trauma-the Effect of Injury Location on Outcomes.

There is limited evidence to suggest that the more distal a penetrating colonic injury, the poorer its expected outcome, prompting consideration of diversion rather than anastomosis when faced with left colonic injury. The clinical outcomes of penetrating colonic trauma in relation to their anatomical location within the colon were reviewed. A review was performed over eight years (2012-2020) of all patients over 18years who had sustained penetrating colon injury and presented to our trauma centre in South Africa. Direct comparison was made between right colon vs left colon injuries. A total of 450 patients were included; right colon: 260, left colon: 190. Gunshots predominated in the right colon, and the PATI was higher in this group. There were minimal differences in admission physiology and blood gas parameters between groups, but higher damage control surgery and ICU admission rates for the right colon group. There were similar rates of primary repair, anastomosis, and stoma between groups. Leak rates were no different between the two groups, and although overall complication rates were higher for the right colon, there was no difference with regard to gastro-intestinal and other complications, nor for mortality. While regression analysis did identify PATI to be a risk factor for overall complications and mortality, it failed to do so for anastomotic leak. Our study did not demonstrate any difference in anastomotic leak rates or mortality between right vs left colonic injury. We recommend that all colonic injuries should be treated on their own merit, balanced against the patient's condition, regardless of anatomical location within the colon.

Evaluation of short-term risk factors associated with dehiscence and death following full-thickness incisions of the large intestine in cats: 84 cases (1993-2015).

To evaluate short-term risk factors associated with dehiscence and death in cats undergoing full-thickness large intestinal incisions. 84 client-owned cats that had undergone full-thickness large intestinal incisions and for which information regarding outcome through postoperative day 7 was available. Medical records from 4 veterinary teaching hospitals were reviewed. For cats that met the inclusion criteria, signalment, history, laboratory test results, surgical and medical procedures, perioperative complications, and outcome were analyzed. A Fisher exact or Wilcoxon rank sum test was used to identify individual variables associated with dehiscence of intestinal incisions or patient nonsurvival to hospital discharge or both. 84 cats met the inclusion criteria. The overall dehiscence and survival to hospital discharge rates were 8.3% (7/84 cats) and 94% (79/84 cats), respectively. Factors associated with dehiscence and nonsurvival to hospital discharge included presence of band neutrophils, performance of partial colectomy with colonic resection and anastomosis, administration of blood products, postoperative cardiopulmonary arrest, and incisional inflammation or infection. Factors associated with nonsurvival to hospital discharge only included low serum globulin concentration, repair of colonic trauma or dehiscence, and postoperative colonic dehiscence. Factors associated with dehiscence only included hypoalbuminemia, renal dysfunction, administration of blood products or > 2 classes of antimicrobials, and intra-abdominal fecal contamination. Results indicated that intestinal dehiscence and mortality rates associated with large intestinal incisions in cats may be higher than previously proposed, although the risk of either outcome was still low. Factors suggestive of systemic illness were associated with colonic dehiscence or death, and focused prospective studies of risk factors are warranted.

Penetrating colonic trauma and damage control surgery: Anastomosis or stoma?

The management of colon injuries in damage control surgery (DCS) remains controversial. A retrospective study investigating outcomes of penetrating colonic trauma in patients who survived beyond the initial repeat laparotomy (IRL) after DCS was performed. Patients over 18 years with penetrating colon injury and who underwent DCS from 2012 to 2020 were included from our electronic trauma registry. Demographic data, admission physiology and Injury Severity Score (ISS) were reviewed. Patients were classified into three groups: primary repair of non-destructive injuries at DCL, delayed anastomosis of destructive injuries at IRL and diversion of destructive injuries at IRL. Outcomes observed included leak rates, length of intensive care unit stay, length of hospital stay, morbidities, mortality and colon-related mortality. Out of 584 patients with penetrating colonic trauma, 89 (15%) underwent DCS. After exclusions, 74 patients were analysed. Mean age was 32.8 years (SD 12.5); 67 (91%) were male. Mechanism of injury was gunshot in 63 (85%) and stab 11 (15%) patients. Seventeen patients underwent primary repair at DCS, of which one leaked. Twenty patients underwent delayed anastomosis at IRL. Of these, five (25%) developed leaks. Mortality was significantly higher for those with an anastomotic leak compared to those without (p< 0.001). Thirty-seven patients were diverted at IRL. Overall mortality (p= 0.622) and colon-related mortality (p= 0.592) were not significantly different across groups. Delayed anastomosis at IRL following DCL was associated with a leak rate of 25% in this study. When anastomotic leak did occur, it was associated with significant mortality. Delayed anastomosis should only be undertaken in highly selected patients.

Love for the Colonizer: Literary and Psychoanalytic Investigations of Brazil's Foundational Trauma

The Brazilian cultural and political project began in 1822 with the end of colonization. At its outset, colonization stood fictitious in its enormous power to shape reality. In Latin America there was a confluence between the politicians and writers of the 19th century that guaranteed wholly pervasive foundational mythologies—the people building the legal-political state were also setting the mythological ideology of the nation in stone. As such, foundational myths served to unify the people under a common national banner. However, in their attempts to overcome the ghost of colonization, they ended up guaranteeing a wholly pervasive structure wherein the repressed trauma could fester. In Brazil, foundational works, like José de Alencar's Iracema, instead of rejecting the trauma of colonization, engendered myths that repressed it, romanticizing a narrative for the people to fall in love with their colonizer. This love, I argue, led to a specific cultural complex that induces a repetition compulsion of the original traumatic event up to this day, guaranteeing unconscious entrapment and a constant return and submission to the figure of the colonizer.

Current Management of Colon Trauma at a Level II Trauma Center - A Single Center Review of Cases from the Last Two Decades.

Introduction: The large bowel is the second most commonly injured hollow viscus in penetrating abdominal trauma following the small bowel. Injuries to the colon are fairly common in times of war and the lessons learned in these instances have historically guided management. The objective of our research is to highlight current management principles as they are applied in a single trauma centre during the last two decades. Material and Method: retrospective review of our clinical experience was performed. Electronic health records from our institution were searched for injuries caused by external forces from January 2003 - October 2021. All patients that were identified with colon injuries were included in the review. Results: We identified 11 male patients with colon injuries during the study period. Repair options used were primary suture or colostomy formation with no anastomoses and no damage control procedures. Mortality was 27.2%, relatively high when compared with contemporaneous studies. Conclusions: The main take home message of our research is that the epidemiology of colon trauma is very different in a civilian environment that has a low caseload of penetrating injury compared to wartime injuries. There is a clear need of prospective multicentre data in this type of trauma cohorts to better define management options and not base our approach on wartime data or data from communities where the rate of penetrating injuries is high.

Fire in the jungle: Genocide and colonization in Russell and Pugh’s The Flintstones

Mark Russell and Steve Pugh’s The Flintstones comic book (2016–17) addresses US colonialism much more directly than most popular media but focalizes its story through a white, settler American. Thus, it represents an unwillingness and/or inability to think outside of that narrow perspective, i.e. while it is anti-colonial, it is not postcolonial. The book was published through a licensing agreement between Hanna-Barbara and DC Comics in which several Hanna-Barbera cartoons were combined with contrasting genres to create grim and/or mature stories. DC’s The Flintstones, in particular, takes on a collection of social issues, including religion as cynical manipulation, military-industrial propaganda, exploitation of foreign/immigrant labour and media depictions of the environmental crisis. However, it consistently undermines its own messages, often through visual jokes that end up confirming the ideas the book satirizes but also through sincere pronouncements that prevent the satirical critique from reaching a concrete conclusion. The overarching narrative of the series is about the lingering trauma of colonization. It equates the colonization of the land presently held by United States with that country’s war in Vietnam. This equation results from depicting the literal colonization of an Indigenous space and land but using imagery that reflects US media depictions of their war in Vietnam: colonialist soldiers in green fatigues use fire (i.e. napalm) to exterminate racist caricatures of Southeast Asian guerrilla fighters in order to clear a forest and expose the literal bedrock from which the Flinstone’s city will be built. Fred Flintstone, who represents a settler American, states quite directly that he ‘participated in a genocide’ as a soldier in that invasion, thus confirming an anti-colonialist critique. However, the book never takes on the perspective of the colonized peoples, who by then have been wiped out, which is why it stops short of a postcolonialist critique.