Colon Trauma Research Articles

Changing patterns in the management of Colonic Trauma

Recent prospective studies have recommended primary repair for all colonic trauma. We evaluate the changing patterns given these recommendations and assess our results of primary repair. This prospective study was conducted on 63 patients with colonic trauma received over a year from July 2000 to June 2001. Morbidity was defined as failure of a primary repair, abscess, fistula, wound dehiscence, sepsis, and organ failure. Primary repairs were performed in 28 patients and colostomy was done in 35 patients. Prolonged mean hospital stay and more incidences of postoperative complications occurred in colostomy group. It was therefore, concluded that primary repair of colon should be adapted as a standard procedure. Colostomy should be reserved for patients with a prolonged delay to surgery, severe blood loss, and gross faecal contamination or associated with multiple organ injuries.

The trauma of colonization: a psycho-historical analysis of one aboriginal community in the north american "northwest"

Abstract This article examines two models of mass trauma as applied to the social conditions and history of an aboriginal community in the boreal forest of northern Canada. A psycho-historical examination of the colonial history of the community failed to uncover evidence of Historic Trauma as pathology linked to the general process of colonization in the Americas. While evidence emerged of a syndrome linked to attendance at regionally specific Indian residential schools, it was not clear whether this syndrome was distinct from Post Traumatic Stress Disorder. It is suggested that the intergenerational transfer of this symptomatology would involve mechanisms of culture that impact self-construction. Community development is proposed as a method for improving local cultures. The use of psycho-historical analysis is recommended for future research. Abstracto Este articulo examina dos modelos de trauma masivo aplicados a las condiciones sociales e historia de una comunidad indigena en los bosques boreales del norte de Canada. Este examen de la historia colonial de la comunidad no descubrio evidencia de trauma historico como patologia relacionada al proceso general de colonizacion de las Americas. Lo que si emergio fue evidencia de un sindrome relacionado con la asistencia a escuelas indigenas residenciales en regiones especificas. No esta claro si este sindrome es distinto al trastorno de estres postraumatico. Se sugiere que el traspaso inter-generacional de esta sintomatologia incluiria mecanismos culturales que influyen en su autoconstruccion. Desarrollo comunitario se propone como metodo para mejorar las culturas locales. El uso de analisis psico historico se recomienda para investigaciones futuras.

FREE PERITONEAL FLUID IN TRAUMA PATIENTS: THE PARADIGM SHIFT

Trauma surgeons are confronted nowadays with various abdominal injuries, with a more and more increased severity, secondary to urban violence and traffic related accidents. We aim to better define the prognostic value of post-traumatic hemoperitoneum (PTH) in the nowadays era of nonoperative management of abdominal lesions, and to correlate it with the current pattern of traumatic injuries. Retrospective study of patients admitted during 24 months. Selections criteria: (1) Traumatic injury; (2) Free peritoneal fluid on preoperative imaging; (3) Surgical exploration of the abdomen. Setting: A level I trauma center. Results: There were 64 patients, with two peak frequencies between 18-35 and 50-70 years old. Abdominal wall ecchymoses were found in 36 (55%) of cases. Out of 64 cases 37 (58.7%) were transportation related, 12 (19%) caused by human aggression and 10 (16.9%) by falls. According to the Trauma Score (TS) there were 50 (78.2%) cases with TS between 14-16, 9 (17.2%) between 10 –13 and 3 (4.8%) with TS <9. More frequent extraabdominal associated lesions were: head injuries – 38 (58.5%), thoracic trauma – 34 (52.3%), orthopedic injuries – 24 (36.9%). Diagnostic peritoneal lavage was performed in 5 (7.8%) cases. FAST has a sensibility of 70.21% and CT scan a sensibility of 100%. Most frequent injured abdominal organs were the spleen – 36 (56.25%), liver 17 (26.56%) and mesentery 14 (21.87%). Laparotomy was performed in 59 (92.2%) of cases, laparoscopy in 2 (3.1%) of cases and conversion to open surgery in 3 (4.7%) cases. Mortality was 23.43%. We observed several predictive factors for mortality on univariate analysis: haemoglobin < 8g/dl (p=0.02), haematocrits < 25% (p=0.01), hemoperitoneum > 1500 ml (p=0.04), colonic trauma (p=0.001), head (p=0.01) and thoracic injuries (p=0.04). Dedicated trauma surgeons should balance between trauma kinetics details, patients’ clinical examination, and diagnostic workup, in an effort to decrease morbidity and mortality secondary to missed injuries or unnecessary laparotomies.

Does acute alcohol intoxication interfere with colonic anastomosis wound healing?: a rat model of nondestructive colon trauma

To evaluate the effects of acute alcohol intoxication on healing of colonic anastomosis. Thirty-six rats were allocated into two groups. Animals in the alcohol (A) were given 2 mL of ethanol diluted in 0.9% saline solution to a concentration of 40% by gavage immediately before anesthesia, whereas control (C) animals received 2 mL of 0.9% saline solution via the same route. A colonic anastomosis was then performed in all animals. On postoperative days 1, 3, and 7, anastomotic breaking strength was assessed and histopathological examination was performed. Change in body weight and mortality were also evaluated. The median of anastomotic tensile strength on the postoperative day 1 was 0.09 Newtons for group A and 0.13 for group C. (p>0.05). The median of anastomotic tensile strength on the postoperative day 3 was 0.13 Newtons for group A and 0.17 for group C. (p>0.05). The median of anastomotic tensile strength on the postoperative day 7 was 0.30 Newtons for group A and 0.35 for group C. (p>0.05). There was no significant difference between the groups A and C, in the first, third or seventh POD (p>0.05), in any of the analyzed parameters. There were no statistical differences between groups in the weight. Three animals died, all from the group A. Acute alcohol intoxication did not interfere with wound healing of colonic anastomoses, although it caused early postoperative mortality.

Outcomes after colon trauma in the 21st century: An analysis of the U.S. National Trauma Data Bank

Most colon trauma data arise from institutional series that provide descriptive analysis. We investigated the outcome of these patients by analyzing a nationwide database. We queried the U.S. National Trauma Data Bank (2007-2009) using primary International Classification of Diseases, 9th edition, Clinical Modification codes to identify colon injuries. Outcomes were stratified by injury mechanism (blunt versus penetrating), segment of colon injured, and management strategy (diversion versus in continuity). There were 6,817 patients who suffered primary colon injuries; 82% were male and 48% experienced blunt injuries. Blunt colon trauma patients were older, had lengthier intensive care stays, and greater rates of morbidity and mortality than those with penetrating injuries (all P < .05). Nonspecified injuries were the most common (36%), followed by transverse colon injuries (24%). The overall fecal diversion rate was 9%, with the highest rates seen in patients with sigmoid colon injuries (15%). Diverted patients were older, had higher injury severity scores, and increased mortality (22% vs 12%; P < .001). Multivariate analysis found that neither mechanism nor fecal diversion were independently associated with increased morbidity or mortality. Sigmoid colon injuries seem to be managed with fecal diversion more often than other segmental injuries. Neither blunt mechanism nor fecal diversion were independently associated with adverse outcomes in colon trauma.

Laughter and Trauma: Making Sense of Colonial Violence

Abstract Aboriginal Australian performances, created from within their own traditional practices, have often dealt with aspects of European colonization and racism in a humorous manner. There are numerous accounts of these, including performances that were satirical and which treated traumatic acts of racialized violence in Australia in a comedic form. Indeed, Aboriginal audiences are documented as laughing uproariously at these performances. Examples include performances from Arnhem Land in the north, which centred on white men abducting women for sexual use; others from Stradbroke Island, off the coast of Queensland, include the ways in which the Europeans in the volunteer land army used their training and arms to kill Aboriginal people. This article examines the translation of traumatic events into comedic performances in the context of the major trauma of colonization, illustrating the particular manner by which humour offers ways of acting out and dealing with events that cause communal and individual traumas.

Lusophonia vs. Lusutopia, MLA vs. MTA

Lusophonia vs. Lusutopia, MLA vs. MTA

Article Commentary: Evolving Colon Injury Management: A Review

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.

Laparoscopic management for non-traumatic colon perforation in children

Although recent reports have seen an increase in acceptance of laparoscopic surgery as treatment for traumatic colon injury, its role in the management of non-traumatic colon perforation in children has not been reported. In this study, we review our experience in laparoscopic non-resectional management for children who presented with non-traumatic colonic perforation. Between October 2003 and May 2011, 15 children who had been diagnosed with colonic perforation and underwent laparoscopic surgery were included in the study. Their medical records were reviewed for analysis. The clinical manifestation of non-traumatic colon perforation in children was non-specific. The most likely aetiology was infective colitis. Solitary perforation at the caecum was the most common finding. The exact perforation site could not be identified in 3 patients. Nine patients had primary closure while 3 patients underwent wedge resection. The single trocar laparoscopic surgery was successful in 12 patients. The mean postoperative hospital stay was 7.3days. For children presenting with suspected non-traumatic colon perforation, laparoscopic management is the desirable approach. The peritoneal lavage, wedge excision and primary repair can be performed with single trocar techniques and is associated with minimal morbidity. Future prospective studies are needed to compare this minimally invasive approach with conventional open surgery.

Outcomes Following Colon Trauma in the 21st Century: an Analysis of the U.S. National Trauma Data Bank (NTDB)

Outcomes Following Colon Trauma in the 21st Century: an Analysis of the U.S. National Trauma Data Bank (NTDB)

Epidemiology of modern battlefield colorectal trauma

Traumatic injuries to the lower gastrointestinal tract occur in up to 15% of all injured combatants, with significant morbidity (up to 75%) and mortality. The incidence, etiology, associated injuries, and overall mortality related to modern battlefield colorectal trauma are poorly characterized. Using data from the Joint Theater Trauma Registry and other Department of Defense electronic health records, the ongoing Joint Surgical Transcolonic Injury or Ostomy Multi-theater Assessment project quantifies epidemiologic trends in colon injury, risk factors for prolonged or perhaps unnecessary fecal diversion, and quality of life in US military personnel requiring colostomies. In the current study, all coalition troops with colon or rectal injuries as classified by DRG International Classification of Diseases-9th Rev. diagnosis and Abbreviated Injury Scale (AIS) codes in the Joint Theater Trauma Registry were included. During 8 years, 977 coalition military personnel with colorectal injury were identified, with a mean (SD) Injury Severity Score (ISS) of 22.2 (13.2). Gunshot wounds remain the primary mechanism of injury (57.6%). Compared with personnel with colon injuries, those with rectal trauma sustained greater injury to face and extremities but fewer severe thoracic and abdominal injuries (p < 0.005). Overall fecal diversion rates were significantly higher in Iraq than in Afghanistan (38.7% vs. 31.6%, respectively; p = 0.03), predominantly owing to greater use of diversion for colon trauma. There was little difference in diversion rates between theaters for rectal injuries (59.6% vs. 50%, p < 0.15). The overall mortality rate was 8.2%. Notably, the mortality rate for patients with no fecal diversion (10.8%) was significantly greater than those with fecal diversion (3.7%, p < 0.0001). Military personnel sustaining colon or rectal trauma continue to have elevated mortality rates, even after reaching surgical treatment facilities. Furthermore, associated serious injuries are commonly encountered. Fecal diversion in these patients may lead to reduced mortality, although prospective selection criteria for diversion do not currently exist. Future research into risk factors for colostomy creation, timing of diversion in relation to damage-control laparotomy, and quality of life in veterans with stomas will produce useful insights and help guide therapy. Epidemiologic study, level III.

Historical and current trends in colon trauma.

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.

Analysis of endoscopic interventions in patients with bowel stomas

Aim. To evaluate potentials and to determine indications for endoscopic interventions in case of bowel stomas surgery. Methods. Case series of 66 patients with bowel stomas who underwent endoscopic interventions at various stages is presented. The causes of stoma formation were: colon cancer (43 patients), colon diverticular disease (10), inflammatory bowel disease (5), colon trauma (4), benign colon tumors (2), dolichosigmo-id (2). Results. Laparoscopic technique was most widely used in cases of acute intestinal obstruction - 39 patients. Laparoscopic subtotal colectomy with Brooke end ileostomy was performed in 3 patients. Laparoscopically assisted reversal was completed in 11 patients after Hartmann’s procedure. Introduction of endoscopic interventions to bowel stoma surgery techniques allowed to reduce the number of post-operative complications. The terms of rehabilitation after radical interventions with complete colon stoma closure in patients with diseases of the colon requiring surgical treatment were decreased to 7-11 days. Conclusion. The use of laparoscopic techniques in bowel stoma surgery is possible at every stage of surgical rehabilitation of patients who underwent colostomy; it is safe and has a number of advantages compared to standard procedures.

Management of Large Bowel Injury During Laparoscopic Surgery

Management of Large Bowel Injury During Laparoscopic Surgery

Colonic injuries and the damage control abdomen: does management strategy matter?

BackgroundThe optimal management of colon injury patients requiring damage control laparotomy (DCL) is controversial. The objective of this study was to assess the safety of colonic resection and anastomosis versus fecal diversion in trauma patients requiring DCL. MethodsPatients with traumatic colon injuries undergoing DCL between 2000 and 2010 were identified by the database and chart review. Those who died within 48h were excluded. Patients were divided into two groups: those undergoing one or more colonic anastomoses with or without distal colostomy (group 1) and those undergoing colostomy only or one or more colonic anastomoses with a protecting proximal ostomy (group 2). Variables were compared using Wilcoxon rank sum, χ2, or Fisher exact tests as appropriate. ResultsSixty-one patients were included (group 1, n=28 and group 2, n=33). Fascial closure rates (group 1, 50% versus group 2, 61%; P=0.45), hospital length of stay (29 versus 23d; P=0.89), and in-patient mortality (11% versus 12%; P=1.0) were similar between groups. There were a total of 11 anastomotic leaks, five of which were related to non-colonic enteric repairs. Colonic anastomosis leak rates were 16% overall (six of the 38 patients), 14% in group 1 (four of the 28 patients), and 20% in group 2 (two of the 10 patients). Compared with patients who did not leak, patients who leaked had a higher median age (37 versus 25y; P=0.05), greater likelihood of not achieving facial closure before post-injury day 5 (18% versus 2%; P=0.003), and a longer hospital length of stay (46 versus 25d; P=0.003). ConclusionsOutcomes after colonic injury in the setting of DCL were similar regardless of the surgical management strategy. Based on these findings, a strategy of diversion over anastomosis cannot be strongly recommended.

Management and Outcomes of Traumatic Colon Injury in Civilian and Military Patients

Divergent injury patterns may indicate the need for differing strategies in combat and civilian trauma patients. This study aims to compare outcomes of colon injury management in these two populations. Parallel retrospective reviews were conducted comparing warfighters (n = 59) injured downrange and subsequently transferred to the United States with civilians (n = 30) treated at a United States Level I trauma center. Patient characteristics, mechanisms of injury, treatment course, and complications were compared. The civilian (CP) and military (MP) populations did not differ in Injury Severity Score (MP 20 vs CP 26; P = 0.41). The MP experienced primarily blast injuries (51%) as opposed to blunt trauma (70%; P < 0.01) in the CP. The site of colon injury did not differ between groups (P = 0.15). Initial management was via primary repair (53%) and resection and anastomosis (27%) in the CP versus colostomy creation (47%) and stapled ends (32%) in the MP (P < 0.001). Ultimately, the CP and MP experienced equivalent continuity rates (90%). Overall complications (MP 68% vs CP 53%; P = 0.18) and mortality (MP 3% vs CP 3%; P = 0.99) did not differ between the two groups. The CP and MP experience different mechanisms and initial management of colon injury. Ultimately, continuity is restored in the majority of both populations.

Indirect Colonic Injury After Military Wounding: A Case Series

Colonic trauma in wartime most commonly results from direct injury along the path of a penetrating missile. Rarely, the colon may be injured by primary blast effect or by propagation of energy by the missile, remote from the track of the projectile. This article describes the clinical presentation and operative findings in five patients who sustained high energy-transfer gunshot wounds (GSWs) or fragmentation injuries from blast who were found to have sustained colonic injuries anatomically remote from the missile track/s. Military surgeons should be aware of the phenomenon of indirect injury to the colon after high-energy transfer GSW and blast injury. A high index of suspicion should be maintained and cross-sectional imaging used where feasible. Primary colonic reconstruction was used safely in these patients with indirect colonic injuries.

Comparing the results penetrating colon injuries based on intervention by surgeons with different levels of experience in West Indies

Background:Numerous studies have established the safety of primary repair for civilian penetrating colonic injuries with little data exploring the experience of surgeon performing the procedure. Owing to financial, staff and administrative constraints in the developing world, surgeons-in-training sometimes find themselves faced with having to perform major surgery for penetrating colonic injuries with no experienced surgeon in attendance, but available for advice via phone. With this thought, we collected retrospective data to analyse our outcomes based on this practice.Materials and Methods:Over a 10-year period 62 patients with penetrating colonic trauma underwent laparotomies with analysis done on 53 cases. Severity of injury, grade of operating surgical staff and outcome were noted. Outcomes of “inexperienced surgeons” and “experienced surgeons” were compared to determine if a difference exists in outcome based on experience or grade of surgeon.Results:A total of 53 patients with penetrating colon injures underwent primary repair and/or anastomosis with 18 (34%) performed by “inexperienced surgeons” and 35 (66%) by “experienced surgeons”. There was one death unrelated to colon trauma with an inexperienced surgeon and one anastomotic leak in a patient operated on by an experienced surgeon.Conclusion:This data supports previous reports on the safety of primary repair for penetrating colonic injuries and raises the point that in cases of lower severity of injury inexperienced surgeons have similar results to experienced surgeons with regard to primary repair.

Management and outcomes of traumatic colon injury in civilian and military patients

Management and outcomes of traumatic colon injury in civilian and military patients

Therapeutic effect of medical glue combined with the great omentum in severe tunica muscularis injury

Twenty-seven patients with severe colon trauma treated in the Shaoxing People’s Hospital from 1995 to 2006 were retrospectively analyzed. The patients with severe tunica muscularis injury were treated by medical glue combined with the greater omentum during operations. The initial result was encouraging. All patients were cured with no anastomotic leakage or abscess. Therefore, reasonable use of medical glue combined with the greater omentum can not only improve the curative rate but also reduces postoperative complications for patients with colon injury.