The impact of mechanism on the management and outcome of penetrating colonic trauma

Abstract

Introduction In light of continuing controversy surrounding the management of penetrating colonic injuries, we set out to compare the outcome of penetrating colonic trauma according to whether the mechanism of injury was a stab wound or a gunshot wound. Methods Our trauma registry was interrogated for the 5-year period from January 2012 to December 2016. All patients over the age of 18 years with penetrating trauma (stab or gunshot) and with intraoperatively proven colonic injury were reviewed. Details of the colonic and concurrent abdominal injuries were recorded, together with the operative management strategy. In-hospital morbidities were divided into colon-related and non-colon related morbidities. The length of hospital stay and mortality were recorded. Direct comparison was made between patients with stab wounds and gunshot wounds to the colon. Results During the 5-year study period, 257 patients sustained a colonic injury secondary to penetrating trauma; 95% (244/257) were male and the mean age was 30 years. A total of 113 (44%) sustained a gunshot wound and the remaining 56% (144/257) sustained a stab wound. Some 88% (226/257) of all patients sustained a single colonic injury, while 12% (31/257) sustained more than one colonic injury. A total of 294 colonic injuries were found at laparotomy. Multiple colonic injuries were less commonly encountered in stab wounds (6%, 9/144 vs. 19%, 22/113, P < 0.001). Primary repair was more commonly performed for stab wounds compared with gunshot wounds (118/144 vs. 59/113, P < 0.001). Patients with gunshot wounds were more likely to need admission to intensive care, more likely to experience anastomotic failure, and had higher mortality. Conclusions It would appear that colonic stab wounds and colonic gunshot wounds are different in terms of severity of the injury and in terms of outcome. While primary repair is almost always applicable to the management of colonic stab wounds, the same cannot be said for colonic gunshot wounds. The management of colonic gunshot wounds should be examined separately from that of stab wounds.

Outcome of trauma-related emergency laparotomies, in an era of far-reaching specialization

“…An additional six patients developed anastomotic leakage. These results are comparable to literature with anastomotic leakage rates of 2-15% following trauma [35][36][37][38][39]. There was a relatively high number of patients who needed a laparotomy several days after the initial trauma in whom a primary anastomosis was performed (2/14 anastomoses > 48 h; 14.2%).…”

Gunshot bullet trauma of the colon in combat patients injured in hybrid period of Russian-Ukrainian war during 2014-2020

“…Similar to other reports, the left colon part (i.e. splenic colon exure, descending and sigmoid colon) and middle colon (ascending and descending colon) were frequently injured as compared to other sites (1,10,(20)(21)(22)(23). The importance to note that colon part injury is related to a higher risk of fecal diversion.…”

“…Unlike other research carried out in this area, we showed multiple injuries to the colon in 58% of patients, which is higher compared to other combat cohorts. For example, Oosthuizen et al showed 12% and Steele et al 15% of multiple injuries in patients diagnosed with more than one injury to the colon in the study of non-combat trauma (20,22). Cardi et al demonstrated multiple segment injuries in both large and small bowel in 21.3% of the patients (24).…”

Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?

“…Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma [1][2][3][4][5] . Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring Damage Control Surgery.…”

“…Las lesiones del intestino y colon representan una alta proporción de todas las heridas ocasionadas por trauma penetrante 1 - 5 . Actualmente, las lesiones aisladas de intestino delgado o colon se manejan con anastomosis primaria o diferida, ya sea por medio de una laparotomía definitiva o una cirugía de control de daños, respectivamente.…”