Applicability of an established management algorithm for colon injuries following blunt trauma

Sharpe, John P.; Magnotti, Louis J.; Weinberg, Jordan A.; Shahan, Charles P.; Cullinan, Darren R.; Fabian, Timothy C.; Croce, Martin A.

doi:10.1097/ta.0b013e31827a36e9

Cited by 25 publications

(15 citation statements)

References 27 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In 2013, the Memphis group once again performed a study to evaluate the impact of their management algorithm on outcomes after blunt colon injury. 49 The authors recognized that blunt colon injuries are obviously different from penetrating injuries, as these wounds are more prone to ischemia. Determination of destructive injuries was based on intraoperative observational criteria different from those used for penetrating wounds.…”

Section: Blunt Colon Woundsmentioning

confidence: 99%

Evolution of the operative management of colon trauma

Sharpe

Magnotti

Fabian

et al. 2017

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

For any trauma surgeon, colon wounds remain a relatively common, yet sometimes challenging, clinical problem. Evolution in operative technique and improvements in antimicrobial therapy during the past two centuries have brought remarkable improvements in both morbidity and mortality after injury to the colon. Much of the early progress in management and patient survival after colon trauma evolved from wartime experience. Multiple evidence-based studies during the last several decades have allowed for more aggressive management, with most wounds undergoing primary repair or resection and anastomosis with an acceptably low suture line failure rate. Despite the abundance of quality evidence regarding management of colon trauma obtained from both military and civilian experience, there remains some debate among institutions regarding management of specific injuries. This is especially true with respect to destructive wounds, injuries to the left colon, blunt colon trauma and those wounds requiring colonic discontinuity during an abbreviated laparotomy. Some programs have developed data-driven protocols that have simplified management of destructive colon wounds, clearly identifying those high-risk patients who should undergo diversion, regardless of mechanism or anatomic location. This update will describe the progression in the approach to colon injuries through history while providing a current review of the literature regarding management of the more controversial wounds.

show abstract

Section: Blunt Colon Woundsmentioning

confidence: 99%

Evolution of the operative management of colon trauma

Sharpe

Magnotti

Fabian

et al. 2017

Trauma Surg Acute Care Open

View full text Add to dashboard Cite

show abstract

“…In comparison, there are limited data on the management of blunt intestinal trauma, which is likely due to the rarity of these injuries. What we do know is that blunt trauma is associated with massive tissue injury based on early clinical and animal data that documents an exaggerated inflammatory response and high injury severity that impacts immune function and possible tissue healing [4][5][6]. These known inflammatory effects may impact outcomes related to decisions regarding primary intestinal repair vs. diversion in blunt injuries.…”

Section: Introductionmentioning

confidence: 95%

“…Algorithms based on the extent of injury, i.e., blood loss, the location of injury (right vs. left) and the degree of colonic wall destruction have also impacted decisions regarding primary repair vs. diversion for penetrating trauma [3,4]. In comparison, there are limited data on the management of blunt intestinal trauma, which is likely due to the rarity of these injuries.…”

Section: Introductionmentioning

confidence: 98%

Not all intestinal traumatic injuries are the same: A comparison of surgically treated blunt vs. penetrating injuries

Adam

Sorensen

Skinner

2015

Injury

View full text Add to dashboard Cite

“…Blunt colon injury is infrequent and is often the result of motor vehicle collisions, followed by assault injuries, pedestrian collisions, and falls. 4 Although seat belt injuries and direct blows to the colon are common mechanism, the massive deceleration force may result in mesenteric tears and ischemic necrosis of the colon. In rare settings, a colonic wall contusion may cause delayed perforation several days after the injury.…”

Section: Epidemiologymentioning

confidence: 99%

“…About a half of patients with blunt colon injuries undergoing laparotomy have serosal wounds involving 50% or greater of the colon wall circumference, mesenteric devascularization, or full-thickness perforations. 4,5 The right colon is the most commonly injured segment followed by the transverse colon or the sigmoid colon, and the left colon. 2,4 Keywords ► nondestructive colon injury ► destructive colon injury ► blunt colon injury ► damage control surgery ► ostomy…”

Section: Epidemiologymentioning

confidence: 99%

Colon Trauma: Evidence-Based Practices

Yamamoto

Logue

Muir

2017

Clinics in Colon and Rectal Surgery

View full text Add to dashboard Cite

Colon injury is not uncommon and occurs in about a half of patients with penetrating hollow viscus injuries. Despite major advances in the operative management of penetrating colon wounds, there remains discussion regarding the appropriate treatment of destructive colon injuries, with a significant amount of scientific evidence supporting segmental resection with primary anastomosis in most patients without comorbidities or large transfusion requirement. Although literature is sparse concerning the management of blunt colon injuries, some studies have shown operative decision based on an algorithm originally defined for penetrating wounds should be considered in blunt colon injuries. The optimal management of colonic injuries in patients requiring damage control surgery (DCS) also remains controversial. Studies have recently reported that there is no increased risk compared with patients treated without DCS if fascial closure is completed on the first reoperation, or that a management algorithm for penetrating colon wounds is probably efficacious for colon injuries in the setting of DCS as well.

show abstract

Applicability of an established management algorithm for colon injuries following blunt trauma

Abstract: Prognostic/epidemiologic study, level III; therapeutic study, level IV.

Cited by 25 publications

References 27 publications

Evolution of the operative management of colon trauma

Evolution of the operative management of colon trauma

Not all intestinal traumatic injuries are the same: A comparison of surgically treated blunt vs. penetrating injuries

Colon Trauma: Evidence-Based Practices

Contact Info

Product

Resources

About