Penetrating Abdominal Trauma Index Research Articles

Are trauma victims with obesity lucky in penetrating trauma injuries?

We aimed to reveal the protective effect of body mass index (BMI) and subcutaneous adipose tissue thickness (SATT), together with scores covering the abdomen, in patients with penetrating abdominal trauma. The data of 234 abdominal penetrating trauma patients over the age of 16 who applied to the emergency general sur-gery unit of Istanbul Medipol Hospital between 2017 and 2021 were analyzed retrospectively. Sex, age, types of penetrating injuries, BMI, need for blood transfusion and intensive care unit (ICU), mortality, Injury Severity Score (ISS), Penetrating Abdominal Trauma Index (PATI), and Flint Colon Injury Score (FCIS) were recorded. The patients were divided into two groups: Gunshot Wound (GW) and Stab Wound (SW).While there was no significant difference in all parameters examined in all patients and GW patients in terms of BMI, a statistically significant difference was found in terms of blood transfusion need in SW patients (p=0.035). As a result of the Receiver Operating Characteristic curve analysis for the SATT variable, the cutoff value between mortality (p=0.866) and SATT (mm) values in all patients was 11 mm for all patients and 12 mm for GW patients. A significant difference was found in all patients and separately in GW and SW groups in terms of ICU and blood transfusion need, length of stay, ISS, PATI, and FCIS scores in non-operated patients (p<0.05). When all patients were examined, a statistically significant difference was found in terms of mortality (p=0.002). It is the first study to evaluate penetrating abdominal injuries with both BMI and SATT comprehensively and with all abdominal scores. A cutoff value to be determined for SATT with larger and multicenter studies can take its place as a parameter in the penetrating trauma algorithm.

The impact of colon injuries on the outcome of gunshot wounds to the abdomen

PurposeFactors predicting morbidity and mortality in patients with colon-related gunshot injuries and the management of these injuries are not always straightforward. This aimed to assess the impact of abdominal gunshot wounds with colonic injuries on patients’ overall outcomes.MethodsThis cross-sectional prospective observational study compared patients with colon injuries and without colon injuries. Data was collected from admission, theatre and postoperative care. Patients were recruited between 1 January 2020 and 20 October 2021.ResultsOf 132 patients with abdominal gunshot injuries, 71 (54.0%) had colon injuries. The colon injury group had a higher incidence of laparotomy wound sepsis (p<0.0001), bullet exit wound infection (p<0.0001), tract necrotizing fasciitis (p<0.0001), relook laparotomies (p<0.0001) and a longer hospital stay (p<0.0001). Septicaemia (p=0.002) or anastomotic leak (p=0.041) was associated with a penetrating abdominal trauma index (PATI) ≥25. Most patients who developed tract necrotizing fasciitis did not have their tract debrided/ lavaged (p=0.004). The type of colon repair did not influence the length of hospital stay (p=0.688) or the development of a colon-related complication (p=0.578). Between 18 and 25 years (p<0.0001) and >2 organs injured (p=0.018) were associated with colon-related complications. Patients between 18 and 25 years were 4.748 times more likely to develop a colon-related complication (p=0.046).ConclusionGunshot wounds to the abdomen with associated colonic injuries had a worse outcome with an increased risk of developing wound infections. There is no difference in the operative management of colonic injury. Patients between the ages of 18 and 25 years or >2 organs injured are more likely to develop a complication.

Risk factors for mortality and morbidity in Syrian refugee children with penetrating abdominal firearm injuries: an 1-year experience.

Despite improvements in technology and surgical techniques, abdominal injuries caused by firearms in children are traumatic with high complication rates and mortality. In this study, factors affecting mortality and complications in penetrating abdominal firearm injuries caused by high-velocity bullets and shrapnel in children as a result of the civil war in Syria were evaluated. This study was conducted as a case series with 53 patients admitted to Kilis State Hospital with penetrating abdominal firearm injuries between January 2016 and February 2017. Patients aged between 6 months and 17 years who suffered penetrating abdominal firearm injuries (PAFI) as a result of the civil war in Syria in the state hospital in Kilis Türkiye border province with Syria and were transferred to our hospital and operated on were included in the evaluation. Patients' sociodemographic information, time to surgery, number of abdominal organs injured, type of firearm causing injury, presence of large vessel injury and extremity injury, presence of thoracic injury requiring thoracotomy in addition to laparotomy, colostomy, penetrating abdominal trauma index, pediatric trauma score (PTS), and shock status were evaluated. In our study, it was found that a high penetrating abdominal trauma index significantly increased complication rates and mortality (P<0.001 and P=0.002, respectively). In addition, it was found that lower PTSs significantly increased the development of complications and mortality (P=0.001 and P<0.001, respectively). Mortality was not observed in any of the patients with a PTS>8, whereas mortality was observed in 27.3% of patients with a PTS≤8, and this result was statistically significant (P=0.003). Shock sig-nificantly increased mortality, and no patient who was not in shock died (P<0.001). In our study, it was determined that the increase in the number of injured intra-abdominal organs had a significant effect on both complications and mortality (P<0.001 and P=0.002, respectively). The penetrating abdominal trauma index and PTS were found to be effective in predicting mortality and morbidity in pediatric patients with PAFI. It is crucial in this patient group to provide appropriate transport after the first intervention is done rapidly and effectively in conflict zones.

Damage control laparotomy outcomes in a major urban trauma centre

BACKGROUND: Damage control laparotomy (DCL) is associated with high mortality. The purpose of this study was to review the outcomes of DCL. METHODS: All patients undergoing DCL for penetrating trauma from May 2015 to July 2017 were reviewed. Data retrieved were demographics, mechanism of injury, vitals, and biochemical parameters. Injury severity was described by the revised trauma score (RTS), penetrating abdominal trauma index (PATI), injury severity score (ISS) and trauma and injury severity score (TRISS). Indications for DCL, length of ICU stay, number of procedures and primary abdominal closure rates, complications and mortality were recorded. RESULTS: Fifty-one patients underwent DCL and 47 patients sustained gunshot injuries. Indications for laparotomy were haemodynamic instability (n = 27) and peritonism in stable patients (n = 22). The medians for the different severity scores were RTS 7.36, ISS 20, and PATI 30. The organs most commonly injured, in decreasing frequency, were small bowel (33), large bowel (25), abdominal vasculature (22), liver (18), stomach (14), kidney (10), diaphragm (10), spleen (9) and pancreas (8). DCL procedures performed were abdominal packing (36), temporary bowel ligation (30), vascular (5) and ureteric (1) shunting. The median number of laparotomies performed per patient was three, with a primary fascial closure rate of 69%. The mortality rate was 29%. CONCLUSION: DCL in our centre is associated with a 29% mortality rate. Severe acidosis, massive blood transfusion in first 24 hours and median PATI score more than 47 are independent risk factors associated with increased mortality.

A contemporary prospective review of 205 consecutive patients with penetrating colon injuries

BackgroundManagement of colon injuries has significantly evolved in the recent decades resulting in considerably decreased morbidity and mortality. We set out to investigate penetrating colon injuries in a high-volume urban academic trauma center in South Africa. MethodsAll patients with penetrating colon injuries admitted between 1/2015 and 1/2018 were prospectively enrolled. Data collection included demographics, injury profile and outcomes. Primary outcome was in-hospital mortality. Secondary outcome was morbidity. ResultsTwo-hundred and five patients were included in the analysis. Stab and gunshot wounds constituted 18% and 82% of the cases, respectively. Mean age was 28.9 (10.2) years and 96.1% were male. Median injury severity score (ISS) and penetrating abdominal trauma index (PATI) were 16 (9-25) and 19 (10-26), respectively. A total of 47.8% of the patients had a complication per Clavien-Dindo classification. Colon leak rate was 2.4%. Wound and abdominal organ/space infection rate was 15.1 and 6.3%, respectively. Overall in-hospital mortality was 9.3%. Risk factors for mortality were higher ISS and PATI, shock on admission, need for blood transfusion, intra-abdominal vascular injury, damage control surgery, and extra-abdominal severe injuries. ConclusionsContemporary overall complication rate remains high in penetrating colon injuries, however, anastomotic leak rate is decreasing. Colon injury associated mortality is related to overall injury burden and hemorrhage rather than to colon injuries.

Non-operative management of civilian abdominal gunshot wounds.

In this study, we aimed to evaluate the results of selective non-operative management in patients with civilian abdominal gunshot wounds. Patients hospitalized and monitored in our clinic due to civilian abdominal gunshot wounds between January 2009 and January 2018 were retrospectively examined. Patients were studied concerning age, gender, mechanism of injury, anatomic injury site, Penetrating Abdominal Trauma Index (PATI), Injury Severity Score (ISS), Revised Trauma Score (RTS), treatment method, time to operation, days of hospitalization and mortality. Of the patients, 84 (89.4%) were male, and 10 (10.6%) were female with a mean age of 32.7 (range 4-60). The mean ISS, RTS and PATI values of all patients were 17.05, 7.27 and 9.21, respectively. Immediate laparotomy and/or thoracotomy were performed in 21 (22.3%) of the patients due to hemodynamic instability and in 27 (28.7%) of the patients because of peritonitis findings. The remaining 46 (48.9%) patients were managed non-operatively. Among these patients, early laparotomy was performed in five (5.3%) and late laparotomy in eight (8.5%) patients who developed peritonitis symptoms. The other 33 (35.1%) patients were treated non-operatively. Of these patients, 61.1% of the patients with flank injuries, 50% of the patients with right thoracoabdominal injuries, 44.4% of the patients with posterior abdominal injuries, 42.1% of the patients with pelvic injuries and 27.8% of the patients with left thoracoabdominal injuries were successfully treated non-operatively. Non-therapeutic or negative laparotomy was performed on six (6.4%) patients. Mortality was 10.6% (n=10) in all patients. Some patients with a civilian abdominal gunshot wound in certain anatomical localization who are hemodynamically stable and have no peritonitis symptoms can be non-operatively managed just as in patients with abdominal stab wounds. Success rates of selective non-operative management are high, especially in gunshot wounds of flank, posterior abdominal, thoracoabdominal and pelvic regions.

Is Time of the Essence: A Retrospective Analysis of Operating Room Procedure Length for First Phase Damage Control Trauma Surgery

Background:The concept of Damage Control Surgery (DCS) consists of a truncated surgical intervention with main focus on hemorrhage and contamination control. Traditionally,DCS involves limiting operating room (OR) time for patients with multiple life-threatening injuries and coagulopathy who are reaching physiologic exhaustion. However, in the modern era of hemostatic resuscitation, there is a paucity of evidence to support a survival benefit with shorter OR times. The objective of this study was to determine the practice habits of trauma surgeons in the modern era of DCS and to determine if operation length affects mortality in trauma patients with abdominal injuries.&#x0D; Methods:An 8-year retrospective review of consecutive adult patients with DCSfor penetrating abdominal trauma at a Level I trauma center was conducted. Patient demographics, injury severity score (ISS), and penetrating abdominal trauma index (PATI) scores were obtained. Average operating room times for initial DCS were determined. Patient outcomes were analyzed with a t-test for univariate analysis and a Cox proportional hazard ratio modeling was used to predict factors for survival. &#x0D; Results:A total of 193 patients were included in the study. The overall patient mortality was 14.0% (n=27/193). Median OR time was 157 minutes (range, 59-573 min). Patients were stratified into short OR group (SHORT, n=95) and long OR group (LORT, n=98) based on the median operative time. Only one patient had an initial DCL less than 60 minutes. The SHORT group received more blood transfusions (52.6% vs. 35.7%, p=0.02) in the ICU. Average operative room time was almost twice as long in the LORT group (214.6+6.2 vs. 121.4+2.6 minutes, p&lt;0.0001). The average hospital length of stay (22.8+2.3 vs. 31.0+3.5 days, p=0.05) and ICU length of stay (10.6+1.2 vs. 12.6+1.4 days, p=0.28) were both lower in the LORT group compared to the SHORT group. The SHORT group had 22 patients with unplanned return to the OR compared to 3 in the LORT group (p&lt;0.0001). On multivariate analysis, OR time was not an independent risk factor for mortality (OR 1.0, 95% CI 0.98-1.0, p=0.48).&#x0D; Conclusions: Modern damage control practices should focus on early and effective surgical hemorrhage control in combination with effective intra-op hemostatic resuscitation efforts and not on how time limitations. These findings suggest that OR time restrictions in the era of effective hemostatic resuscitation in combination with DCS does not impact mortality.

Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa

BackgroundThis study set out to review a large series of trauma laparotomies from a single center and to compare those requiring damage control surgery (DCS) with those who did not,...

Diagnostic laparoscopy or selective non-operative management for stable patients with penetrating abdominal trauma: What to choose?

Background:Selective non-operative management (NOM) and diagnostic laparoscopy (DL) are well-accepted approaches in the management of stable patients with penetrating abdominal trauma (PAT). The aim of this pilot study was to investigate the advantages and disadvantages of early DL in stable asymptomatic or minimally symptomatic patients with PAT as opposed to NOM, a standard of care in this scenario. The secondary aim was to suggest possible indications for DL.Methods:Patients managed with DL or NOM over a 12-month period were included in this study. The age, gender, mechanism and location of injuries, trauma scores, haemodynamic and metabolic parameters, intraoperative findings and length of hospital stay (LOS) were recorded and correlated with outcomes.Results:Thirty-six patients were in the NOM group and 35 in the DL group. Stab wounds were more common. The most common location of injury was the anterior abdominal wall in the NOM group and the lower chest in the DL group. Computed tomography (CT) scan was performed more often in the NOM group (75% vs. 17.1%). The injury severity score (ISS), New ISS and PAT Index were higher in the DL group. Nearly 23 (66%) patients in the DL group had a penetration of the peritoneum, but no significant abdominal injuries. LOS in the NOM group was 2 days versus 3.1 days in the DL group. There were no missed injuries, complications or mortality.Conclusion:NOM is a preferred modality for minimally symptomatic stable patients. However, there is a risk of missed injuries and delayed treatment. DL accurately visualizes injuries, decreases unnecessary CT scans and avoids nontherapeutic laparotomies.

Experiences of Conflict Zone-Related Ballistic Renal Injury.

To analyze our approaches and experiences in patients with renal injuries accompanying penetrating abdominal injuries admitted to the hospital due to high kinetic energy weapons. Patients including renal injuries associated with penetrating abdominal injuries due to gunshot wounds and fragments of shell treated at our institution between February 2002 and May 2013 were retrospectively analyzed. Total 21 patients were included in this study, 20 of whom (86.2%) were male and 1 (13.8%) female. Renal injury was scaled in 2 patients as grade 1, 4 patients as grade 2, 4 patients as grade 3, 8 patients as grade 4, and 3 patients as grade 5. While conservative treatment was applied to patients with grade 1 and 2 injuries, 2 patients with grade 3 injury underwent renal repair and the other 13 patients underwent nephrectomy. The amount of blood transfused in all cases was determined to be mean 8.28 (6-16) units for red blood cells (ES) and 9 (6-17) units for fresh frozen plasma. When patients were assessed according to the Penetrating Abdominal Trauma Index (PATI) scores, the median score and average PATI score were 35 and 37.6 (10-70), respectively. A physical examination along with a quick assessment of vital signs should be made, and unnecessary and time-consuming investigations such as abdominal tomography and angiographic intervention should be avoided. Conservative and organ preservation should be considered absolutely for appropriately selected patients, namely in stable patients in whom kinetic energy transfer is less and who have bullet path away from midline. However, the majority of these patients are considered to be hemodynamically unstable condition, possible complications of the procedure to be applied, and selection of patients should be carefully evaluated.

Abdominal gunshot wounds—a comparative assessment of severity measures

BackgroundPenetrating abdominal trauma is a common feature of trauma treated in low- and middle-income countries (LMICs). The penetrating abdominal trauma index (PATI) and the injury severity score (ISS) are severity-measures most often used to gauge injury severity. It remains unclear which measure better accounts for the severity of sustained injuries. This study compares the predictive ability of both injury severity measures in patients presenting to an LMIC in South Asia. MethodsAll isolated gunshot wounds to the abdomen presenting to a university hospital between 2011 and 2012 were included. ISS and PATI were calculated for each case. Primary outcome measures included all-cause mortality and complications. Multivariable analysis adjusting for age, sex, referral status, hypotension, tachycardia, and injury severity measures was performed. The area under the receiver operating characteristic (AUROC) curve were further calculated to compare the respective abilities of ISS and PATI at predicting death and complications. ResultsA total of 70 patients were included. The average age on presentation was 34.5 y (±11.4) within a predominantly male (n = 68, 97.1%) cohort. Most gunshot wounds were intentionally inflicted (n = 67, 95.7%). The crude rates of death and complications were 34.3% and 15.7%, respectively. The median ISS was 14 (interquartile range: 11–21), and the median PATI was 16 (interquartile range: 9–26). AUROC analysis revealed that ISS was comparable with PATI at predicting mortality (AUROC [95% confidence interval]: 0.952 [0.902–1.00] versus 0.934 [0.860–1.00]) and complications (AUROC [95% confidence interval]: 0.868 [0.778–0.959] versus 0.895 [0.815–0.975]). ConclusionsThe predictive ability of ISS and PATI severity measures was found to be comparable. The results suggest that both measures can be used to risk-stratify patients with isolated abdominal gunshot wounds in an LMIC.

Künt Travmaya Bağlı İntestinal Yaralanmalar

Background: Abdominal hollow organ injuries due to blunt trauma are uncommon, but as they are usually diagnosed late, mortality and morbidity rates are high. In this study, we aimed to analyze the diagnostic methods and results of patients with hollow organ injury related to blunt trauma. Methods: From December 2008 to December 2011, eight patients with abdominal hollowed organ injury related to blunt trauma were prospectively included in the study. Two patients with hemodynamic instability undergoing emergent laparotomy were excluded from the study. Results: Hollow organ injuries accounted for 9.3% of all cases with abdominal blunt trauma. Injuried organs were jejunum (n=2), ileum (n=2), caecum and ascending colon (n=1) and transverse colon (n=1). Due to the development of peritonitis signs and suspicious computarized tomography findings, five patients underwent surgery during the 7-24 hours of follow-up, while one patient underwent emergent laparotomy because of organ evisceration. Two patients underwent laparoscopy. The mean ISS(Injury Severity Score) and PATI(Penetrating Abdominal Trauma Index) values were 15.2 and was 9.8, respectively. One patient with caecum and ascending colon injury died due to sepsis (16.7%). Conclusion: Mechanism of trauma and serial physical examination are important diagnostic factors. Free intra-abdominal fluid without solid organ injury in computarized tomography and the presence of signs of peritonitis may be diagnostic. Key words: Blunt; Trauma; Hollow Organ Injury.

The affecting factors on the complication ratio in abdominal gunshot wounds

We aimed to investigate the affecting factors on the complication ratio in abdominal gunshot wounds. Twenty-one patients with abdominal gunshot wounds were analyzed between February 2002 and May 2005. The effects of the interval between trauma and presentation to the hospital, the number of injured abdominal and extra-abdominal organs, penetrating abdominal trauma index (PATI), and blood transfusion were evaluated. 90.4% of all patients were transported to the hospital and underwent their first evaluation in the first two hours. The complication rate was 7.1% in patients who had <3 injured organs and 71% in the others (p<0.0001). 71.4% of the patients had isolated abdominal trauma, while 28.6% had additional extra-abdominal organ trauma. The complication rate was 7.7% in 13 patients with PATI score <25 and 62.5% in 8 patients with a PATI score ≥25 (p<0.0001). In 10 patients who underwent blood transfusion of ≥3 units, the complication rate was 50% (p<0.0001). In our study, PATI score, multiple blood transfusions and the number of injured intra-abdominal organs were the most important factors affecting the rate of postoperative complications in penetrating abdominal gunshot wounds. We found that the interval between trauma and presentation to the hospital and number of injured extra-abdominal organs did not affect the complication rate.

Independent Predictors of Treatment Modality for Penetrating Colon Injury.

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. 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. 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). 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.

Wartime major venous vessel injuries

The aim of this study is to declare our experience and to identify the important factors that influence the mortality and morbidity in patients with combat-related penetrating wounds of the abdomen (CR-PWA) with major venous vessel injuries. Twenty-six wounded with combat-related injuries of major abdominal venous vessels, admitted in the University Clinic cardiovascular surgery department during the period from 1 August 1991 through 30 October 1995, were analyzed. Patients with concomitant injured arteries and extra-abdominal injuries (n=150; 85.2%) were excluded from this study. The Penetrating Abdominal Trauma Index (PATI) score for each patient was calculated. Fifteen patients (57.69%) sustained with PATI score greater than 25 died. The mean duration of hospitalization was 16 days (range 0-86). The average hospitalization time for those surviving their complications was 17 days with a PATI of 25 or less, and 43 days with a score more than 25. Three clinical assessments of the long-term outcome were performed after a median of about 3, 5 and 10 years, respectively. Surviving patients (42.31%) were symptom free and had normal Duplex scans as well as no other surgical related complications. Higher PATI scores, postoperative complications and reoperations exert an unfavorable effect on patient outcome.

Is Fecal Diversion Necessary for Nondestructive Penetrating Extraperitoneal Rectal Injuries?

Current management of penetrating extraperitoneal rectal injury includes diversion of the fecal stream. The purpose of this study is to assess whether nondestructive penetrating extraperitoneal rectal injuries can be managed successfully without diversion of the fecal stream. This study was performed at an urban Level I trauma center during a 28-month period from February 2003 through June 2005. All patients who suffered nondestructive penetrating extraperitoneal rectal injuries were managed with a diagnosis and treatment protocol that excluded fecal stream diversion. Patients were placed in one of two management arms based upon clinical suspicion for intraperitoneal injury. In the first arm, patients with suspicion for rectal injury and a positive clinical examination for intraperitoneal injuries were delivered to the operating room for exploratory laparotomy. Proctoscopy was performed before exploratory laparotomy. Extraperitoneal rectal injuries were left to heal by secondary intention. Intraperitoneal rectal injuries were repaired primarily. Patients did not receive fecal diversion or perineal drainage. In the second management arm, patients with a negative clinical examination for intraperitoneal injury and wounding agent trajectory suspicious for rectal injury underwent diagnostic peritoneal lavage (DPL), cystography, and proctoscopy in the emergency room. Positive DPL or cystography warranted laparotomy as above. Patients with positive proctoscopy alone were admitted and placed on a clear liquid diet. Barium enema was performed 5 to 7 days postinjury for all rectal injuries with diets advanced accordingly.A matched historic control group of rectal injury patients who underwent fecal diversion was compared with the nondiversion protocol group. Patients from both groups were matched for penetrating abdominal trauma index (PATI), age and mechanism of injury. There were 14 consecutive patients diagnosed with penetrating rectal injury placed in the nondiversion management protocol. Of these, 9 (64%) patients in the nondiversion group required laparotomy. The average age in the diversion historical control group was 30.5 years and 29.3 years in the nondiversion group. The average PATI in the diversion group was 15.3 and 16.1 in the nondiversion protocol group. The average length of stay for the diversion and nondiversion groups was 9.8 days (range, 7-15) and 7.2 days (range, 4-10), respectively. There were no complications associated with rectal injuries in either group. Nondestructive penetrating rectal injuries can be managed successfully without fecal diversion. Randomized prospective study will be necessary to assess this management method.

Traumatismos de veia cava inferior

OBJETIVO: Avaliar a incidência, o perfil clínico e as estratégias operatórias dos ferimentos de Veia Cava Inferior (VCI). MÉTODOS: Foram analisados retrospectivamente os prontuários de 76 doentes com ferimento de VCI atendidos nos dois prontossocorros de Manaus, no período de janeiro de 1997 a julho de 2002. Mecanismo de lesão, mortalidade, estado hemodinâmico, índice de trauma abdominal penetrante (PATI), achados intra-operatórios e conduta cirúrgica foram estudados. RESULTADOS: Quarenta e nove (65%) doentes sofreram lesão por arma branca, 26 (34%) por arma de fogo e um por traumatismo abdominal fechado. Quarenta e um (54%) doentes sobreviveram. Quase todos chegaram acordados, entretanto 40% estavam hipotensos (pressão arterial sistólica &lt; 70mmHg). O índice de trauma abdominal penetrante (PATI) médio foi maior que 40. À laparotomia, todos demonstraram sangramento retroperitoneal ativo ou hematoma retroperitoneal em expansão. Vinte e um pacientes possuíam lesão de VCI retro-hepática, enquanto nos outros 55 a lesão era infra-hepática. O reparo operatório predominante foi a venorrafia lateral em 65 doentes. Houve necessidade de tóraco-freno-laparotomia em quatro doentes do total de oito doentes que foram à toracotomia direita por lesão retro-hepática. Foram realizados shunts átrio-cavais em seis doentes, dos quais três sobreviveram. CONCLUSÕES: O ferimento de VCI é uma lesão de alta letalidade e possui uma relação intrínseca com a violência urbana. A sobrevivência depende de uma imediata e vigorosa reposição de volume, um manejo operatório adequado e todo esforço em evitar-se hipotermia.

Penetrating Abdominal Vena Cava Injuries

Objective The surgical management and outcome of abdominal vena cava (AVC) injuries is presented. Study design, patients and methods A retrospective record review of patients with AVC injuries treated in the Trauma Unit at Groote Schuur Hospital between January 1999 and December 2003 was undertaken. Demographic data, mechanism of injury, surgical management, associated injuries, duration of hospital stay, complications and mortality were extracted from patient records. Patients with acute peritonitis and/or shock underwent emergency laparotomy. Results Forty-eight patients with AVC injuries were identified. Gunshot wounds accounted for 45 (94%) injuries. The mean weighted revised trauma score, injury severity score (ISS) and penetrating abdominal trauma index (PATI) were 6.3, 24 and 42, respectively. The AVC injury was infrarenal and suprarenal in 41 and seven patients, respectively. Thirty injuries were ligated. There were 15 deaths (31%). Significant differences between survivors and non-survivors included ISS, preoperative hypotension and blood transfusion requirements, whereas site of injury, PATI, and surgical management did not. Conclusion Abdominal vena cava injuries are associated with a high mortality. Ligation of the AVC in critically ill patients is a feasible and life-saving option.

The conundrum of traumatic colon injury

Background Surgical care in the case of traumatic injury to the colon has changed significantly. During World War II, diversion was dictum. Current trends favor primary repair. Methods A retrospective chart review of traumatic colon injuries at an urban level 1 trauma center was performed. Multiple data points were collected. Colon-related complications were examined in detail. Results Seventy-four charts fulfilled inclusion criteria. The majority of patients were treated with primary repair. The median Colon Injury Scale (CIS) grade was 2, and the average Penetrating Abdominal Trauma Index (PATI) score was 19. Patients repaired by diversion suffered more colon-related complications; however, the difference was not statistically significant. Conclusions The emerging dictum for traumatic colon injuries is primary repair. Questions remain as to whether primary repair is the safest option for all colon injuries. The PATI score, CIS grade, and multiple other factors should be included in the decision making algorithm with an emphasis on primary repair.

A Ten-Year Study of Penetrating Injuries of the Colon

Colon injury has been associated with a high risk of septic complications and mortality. We prospectively studied the pattern, management, outcome, and prognostic factors in patients who sustained penetrating colon injuries. Sixty patients who presented to our hospital with penetrating colon injuries over a ten-year period (1992 to 2001) were studied. Colon wounds were caused by gunshots in 55 (91.7 percent) patients and knife stabs in 5 (8.3 percent). There was a delay of more than 12 hours before laparotomy in 30 (50 percent) patients. Moderate or major fecal contamination of the peritoneal cavity occurred in 58 (96.7 percent) patients. The average penetrating abdominal trauma index score was 25.9 and 20 (33.3 percent) patients sustained Flint Grade 3 colon injury. Associated intra-abdominal injuries occurred in the small bowel (73.3 percent), liver (25 percent), stomach (23.3 percent), and mesentery (16.7 percent). Right colon wounds (35) were managed by primary repair in 24 (68.6 percent) patients and proximal diverting colostomy in 11 (31.4 percent), whereas left colon wounds (25) were managed by diverting colostomy in 22 (88.0 percent) patients and primary repair in 3 (12.0 percent) patients. Common complications included wound infection (56.7 percent), septicemia (31.7 percent), and enterocutaneous fistula (16.7 percent). The overall mortality rate was 33.3 percent and colon injury-related mortality was 21.7 percent. Presence of destructive colon injury was associated with a greater than fourfold increased incidence of death. Other significant risk factors included shock on admission, major fecal contamination, duration of operation more than four hours, penetrating abdominal trauma index score >25, and more than two postoperative complications. There was no difference in outcome between patients who had primary repair and those undergoing diverting colostomy. Colostomy closure-related morbidity was 21 percent and mortality was 5.3 percent. A more liberal use of primary repair is required in our patients with penetrating injuries of the colon.