The use of damage-control principles for penetrating pelvic battlefield trauma

Arthurs, Zachary M.; Kjorstad, Randy; Mullenix, Phillip; Rush, Robert M.; Sebesta, James A.; Beekley, Alec C.

doi:10.1016/j.amjsurg.2006.02.009

Cited by 53 publications

(33 citation statements)

References 10 publications

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“…Similarly, in a series of 28 patients with penetrating pelvic injuries, 43 percent sustained extraperitoneal rectal injuries, one-half of which had associated major vascular injuries and 43 percent with associated urologic injuries. 45 More than onethird of patients with rectal and vascular injuries died within one week, highlighting the devastation and increased mortality associated with this injury complex. As advances, such as damage-control procedures, become more commonplace, these rates may decrease; however, this data underscores the high morbidity associated with these injuries.…”

Section: Discussionmentioning

confidence: 99%

Colon and Rectal Injuries During Operation Iraqi Freedom: Are There Any Changing Trends in Management or Outcome?

Steele¹,

Wolcott²,

Mullenix³

et al. 2007

Diseases of the Colon &Amp; Rectum

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Section: Discussionmentioning

confidence: 99%

Colon and Rectal Injuries During Operation Iraqi Freedom: Are There Any Changing Trends in Management or Outcome?

Steele¹,

Wolcott²,

Mullenix³

et al. 2007

Diseases of the Colon &Amp; Rectum

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“…5 In the most severely injured patients, damage control surgery (DCS) with emphasis on stopping life-threatening hemorrhage, controlling enteric spillage, and focused, expeditious patient resuscitation, has been successfully applied in the civilian and military trauma settings. [6][7][8][9] While DCS undoubtedly saves lives when judicially applied, how the well-established practice of fecal diversion relates to the newer wartime damage control techniques remains uncertain. 4,[10][11][12][13][14] Both primary colonic repair or resection with anastomosis carry increased morbidity in the wartime and civilian trauma setting, particularly when combined with DCS techniques.…”

mentioning

confidence: 99%

Risk factors for colostomy in military colorectal trauma: A review of 867 patients

Watson¹,

Aden²,

Engel³

et al. 2014

Surgery

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Background. Limited data exist examining the use of fecal diversion in combatants from modern armed conflicts. Characterization of factors leading to colostomy creation is an initial step toward optimizing and individualizing combat casualty care. Methods. A retrospective review of the US Department of Defense Trauma Registry database was performed for all US and coalition troops with colorectal injuries sustained during combat operations in Iraq and Afghanistan over 8 years. Colostomy rate, anatomic injury location, mechanism of injury, demographic data, and initial physiologic parameters were examined. Univariate and multivariate analyses were conducted. Results. We identified 867 coalition military personnel with colorectal injuries. The overall colostomy rate was 37%. Rectal injuries had the highest diversion rate (56%), followed by left-sided (41%) and right-sided (20%) locations (P < .0001). Those with gunshot wounds (GSW) underwent diversion more often than blast injuries (43% vs 31% respectively, P < .0008). Injury Severity Score $16 (41% vs 30%; P = .0018) and damage control surgery (DCS; 48.2% vs 31.4%; P < .0001) were associated with higher diversion rates. On multivariate analysis, significant predictors for colostomy creation were injury location: Rectal versus left colon (odds ratio [OR], 2.2), rectal versus right colon (OR, 7.5), left versus right colon (OR, 3.4), GSW (OR, 2.0), ISS $ 16 (OR, 1.7), and DCS (OR, 1.6). Conclusion. In this exploratory study of 320 combat-related colostomies, distal colon and rectal injuries continue to be diverted at higher rates independent of other comorbidities. Additional outcomes-directed research is needed to determine whether such operative management is beneficial in all patients. (Surgery 2014;155:1052-61.)

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“…Arthurs et al (1) have reported the most lethal combination of injuries due to penetrating pelvic trauma to be hemorrhage and sepsis, vascular and rectal injury in a series of 28 patients. The American Association for the Surgery of Trauma (AAST) has developed a grading system for organ injury severity; the severity of bladder injuries is measured by an AAST organ injury severity scale (Table) (2).…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of a Gunshot Injury: No Urinary Symptoms with a Voided Bullet

Ceylan¹,

Kozacıoğlu²,

Şen³

et al. 2016

Haseki

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Case Report / Olgu SunumuGunshot injuries to the abdominal cavity are cases of emergency which can be life-threatening depending on the organ/s affected.High-velocity penetrating injuries can cause both a penetrating injury to the organs on its' route or can cause blast injury nearby. In most of the cases, the bullet can be found and the defect can be repaired intraoperatively.Here, we present a rare case of a patient with an intrabdominal penetrating gunshot wound with no organ injury, including the bladder, who voided the bullet spontaneously 30 days after the injury. Keywords: Bladder, cystogram, gunshot wound, traumaKarın boşluğuna ateşli silah yaralanmaları etkilenen organlara göre hayati tehlike yaratabilen, nadir görülen bir acil başvuru nedenidir. Yüksek hız delici yaralanmalar hizasındaki etkilediği organda penetran yaralanmaya sebep olmakla birlikte, komşu organlarda patlama tarzında yaralanmaya yol açabilmektedir. Olguların çoğunda, mermi bulunabilir ve yaralanma intraoperatif tamir edilebilir.Karın boşluğuna ateşli silah yaralanması olan, mesane dahil hiç bir organın yaralanmadığı, 30 gün sonra kurşunu spontan olarak işeyen, nadir görülen olgumuzu sunmayı amaçladık.Anahtar Sözcükler: Mesane, sistogram, ateşli silah yaralanması, travma Ad dressforCor res pon den ce/Ya z›fl maAd re si:Volkan Şen

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The use of damage-control principles for penetrating pelvic battlefield trauma

Cited by 53 publications

References 10 publications

Colon and Rectal Injuries During Operation Iraqi Freedom: Are There Any Changing Trends in Management or Outcome?

Colon and Rectal Injuries During Operation Iraqi Freedom: Are There Any Changing Trends in Management or Outcome?

Risk factors for colostomy in military colorectal trauma: A review of 867 patients

A Rare Case of a Gunshot Injury: No Urinary Symptoms with a Voided Bullet

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