Characteristics of Combat-Associated Small Bowel Injuries

Abstract

We found that two-thirds of service members with small bowel injuries also had a large bowel injury. One-third of the patients required diversion and two-thirds had more than one laparotomy. The pattern of bowel injury significantly affected the need for repeat laparotomy and fecal diversion.

Outcomes of Exploratory Laparotomy and Abdominal Infections Among Combat Casualties

“…19,20 Rates of abdominal SSIs typically range from 13%-40% depending on the type of procedure and organ involved, with colorectal procedures constituting the highest SSI risk. 2,[9][10][11][12][13][20][21][22] With battlefield trauma, injury mechanisms include high-energy gunshot wounds or blast injuries, which are not usually observed in civilian trauma. Furthermore, the blast mechanism of injury often inflicts unique wounding patterns and concomitant damage, and the surrounding environment may harbor unique organisms that contaminate wounds.…”

“…Furthermore, the blast mechanism of injury often inflicts unique wounding patterns and concomitant damage, and the surrounding environment may harbor unique organisms that contaminate wounds. 1,2,13,[23][24][25][26][27][28] As a result, battlefield trauma frequently results in grievous polytrauma, including penetrating abdominal injuries that require initial intervention in an austere environment. Despite these factors, the proportion of abdominal SSIs (14%) observed in our study was at the low end of rates reported in civilian patients with trauma (13%-40%).…”

“…Despite these factors, the proportion of abdominal SSIs (14%) observed in our study was at the low end of rates reported in civilian patients with trauma (13%-40%). 2,[9][10][11][12][13][20][21][22] Deep SSIs tended to particularly morbid, as many of these patients (46.9%) underwent laparotomies for fascial dehiscence or frequent washouts for invasive fungal infections. Mesh (biologic or synthetic) adjuncts were subsequently used to achieve fascial closure in 20.4% of patients with SSIs, compared with 2.1% of patients without abdominal SSIs.…”

“…2,10,13,22,27 Hollow viscus injuries, especially colorectal organs, portend a higher risk of SSI because of the contamination of a formerly sterile body cavity with enteric contents. [9][10][11][12][13]29 Duodenal and pancreatic trauma have also been historically associated with increased risk of SSI. 2 Recognition of the serious complications associated with certain hollow viscus injuries historically often led to more conservative surgical management in certain contaminated cases.…”

“…Although intra-abdominal infections have been evaluated in civilian populations, [9][10][11][12] less information is available for battlefield abdominal trauma. 2,13 Our objective was to examine the incidence and epidemiology of surgical site infections (SSIs) after laparotomy performed for combat-related abdominal trauma sustained in Iraq and Afghanistan. In addition, we elicited survival and abdominal closure characteristics in patients with and without abdominal SSIs.…”