Damage Control Surgery for Abdominal Trauma

Chaudhry, Rajan; Tiwari, GL; Singh, Yogendra

doi:10.1016/s0377-1237(06)80015-8

Cited by 7 publications

(8 citation statements)

References 38 publications

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“…Regardless of its primary benefits, in this study setting, damage control surgery was shown as a risk factor for mortality. It was also reported in a previous study that complications and mortality were high in patients undergoing damage control surgery ( 36 ). Complications such as wound infection rate (50%–100%), intraabdominal abscess (25%–8%), enterocutaneous fistula (20%–25%), abdominal hypertension in 20% of patients, and mortality (12%–67%) were reported in various studies ( 37 – 39 ) Therefore, the trauma surgeon should follow the recommended guidelines for the application of damage control surgery to minimize mortality rates.…”

Section: Discussionsupporting

confidence: 61%

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

et al. 2022

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BackgroundPenetrating abdominal injury (PAI) is a public health problem and accounts for significant mortality and disability in both developing and developed countries. It often causes damage to internal organs, resulting in shock and infection. In this study, we assessed the outcomes of PAI and factors associated with post-surgical outcomes including surgical site infection (SSI) and in-hospital death.MethodsAn institution-based cross-sectional study was conducted from 15 January to January 30, 2020, using a standard checklist to review the clinical charts of patients who presented to Hiwot Fana Specialized University Hospital (HFSUH) with PAI and underwent laparotomy between January 2015 and September 2019. Descriptive statistics were used to describe the characteristics of patients, and odds ratios (ORs) with a 95% confidence interval (CI) were reported for factors included in binary logistic regression. The statistical significance was declared at a P-value <0.05.ResultsA total of 352 charts of patients with PAI were reviewed. A majority of them (84.9%) were males and the mean age was 26.5 years. The anterior abdomen was the most common site of injury, accounting for 285 patients (81%), 329 patients (93.5%) suffered organ injury, 204 (62%) had a single organ injury, and 125 (38%) had more than one organ injury. The leading injured organs were small intestines 194 (55.1%), followed by the colon 88 (25%) and liver 40 (11.4%). The magnitude of SSI and hospital death was 84 (23.9%) and 12 (3.4%), respectively. Patients above 45 years of age (AOR = 2.9, 95% CI: 1.2, 9.2), with fluid collection (AOR = 2.7, 95% CI: 1.2, 5.9), colostomy (AOR = 3.9, 95% CI: 1.9, 7.8), body temperature >37.5 °C (AOR = 3.8,95% CI:1.9,7.6), and Hgb < 10 mg/dl (AOR = 7.4, 95% CI: 3.4,16.1) had a higher likelihood of SSI. Those patients admitted to the intensive care unit (AOR = 21.3, 95% CI: 1.1, 412.3) and who underwent damage control surgery (AOR = 9.6, 95% CI: 1.3, 73.3) had a higher likelihood of mortality.ConclusionsSSI and death among patients with PAI were high. Age, fluid collection, colostomy, body temperature, and hemoglobin level were statistically associated with SSI, and intensive care unit and damage control surgery were statistically associated with death. Therefore, health professionals working in surgical wards should consider these factors to alleviate SSI and prevent death. Broadly speaking, the guidelines of the World Society of Emergency Surgery (WSES) should consider these factors in their recommendations.

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Section: Discussionsupporting

confidence: 61%

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

et al. 2022

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“…Damage control surgery was described in the 1980s as an option for haemodynamically unstable abdominal trauma patients with severe exsanguinating injuries [21]. Patients who demonstrate the triad of coagulopathy, hypothermia, and acidosis in emergency situations are candidates for it [22].…”

Section: Discussionmentioning

confidence: 99%

“…Patients who demonstrate the triad of coagulopathy, hypothermia, and acidosis in emergency situations are candidates for it [22]. It is accomplished by initial abbreviated laparotomy, correction of abnormal physiological parameters, and later definitive injury repair during a second operation [21]. A 3 ½ year retrospective study evaluated the medical records of 46 patients who suffered penetrating abdominal trauma which necessitated laparotomy and urgent transfusion of over 10 units of packed red blood cells [22].…”

Section: Discussionmentioning

confidence: 99%

“…We also explore the historical use of pancreaticoduodenectomies on paediatric trauma cases by reviewing two case reports and one case series [4,5,20]. There is also an analysis of 2 retrospective studies as well as a review article on indications for damage control surgery [[21], [22], [23]]. Finally, we examine a prospective and a retrospective study which explore general indications for pancreaticoduodenectomies in trauma patients [24,25].…”

Section: Introductionmentioning

confidence: 99%

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Modified Whipple on an 18-month-old with traumatic pancreatic transection and duodenal rupture

Hyser

Sahhar

Woollen

2019

Trauma Case Reports

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The emergence of the Whipple procedure revolutionized operative management of pancreatic disease since its introduction (Fernandez-del Castillo et al., 2012 [ 1 ]). This operation classically involves removal of the head of the pancreas along with the duodenum, gallbladder, a portion of the bile duct, and part of the stomach (Warshaw and Thayer, 2004; Evans et al., 2007 [ 2 , 3 ]). We report a beneficial outcome of a modified Whipple on a paediatric trauma patient post- motor vehicle accident (MVA). After Advanced Trauma Life Support (ATLS) was initiated and haemodynamic stability was achieved, exploratory laparotomy revealed pancreatic transection and duodenal rupture. Partial pancreaticoduodenectomy, pancreaticoduodenostomy, cholecystojejunostomy, and pyloric-sparing gastrojejunostomy were performed. Post-operative acute pancreatitis resolved with antibiotics and supportive care. While paediatric abdominal trauma does not typically warrant a Whipple, patients with severe injury to the pancreas and neighboring organs with major vascular injury may offer no other intra-operative choice (Adams, 2014; Thatte and Vaze, 2014; Debi et al., 2013 [ [4] , [5] , [6] ]). Our patient's growth was followed post-operatively. At a 20-year post-operative follow-up, he reported no further hospitalizations or complications such as diabetes, biliary stricture, gallstones, or growth retardation. We review the literature to expose the novelty of using a Whipple to treat paediatric abdominal trauma, and the advantages of a pylorus-preserving Whipple. Indications for damage control surgery and non-operative management were contrasted with those for definitive surgery to reconstruct the biliary tree to further elucidate why the latter option was chosen.

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“…Damage control surgery consisting of an initial abbreviated surgery to control bleeding and contamination, followed by correction of hypothermia, coagulopathy, and acidosis in the critical care unit and timely re-exploration, has promising outcomes in the management of patients with critical trauma [ 12 ]. Endoscopic closure by endoclips is found to be a safe, feasible, and effective technique for the treatment of ERCP-related duodenal perforation [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Management of horizontal duodenal perforation: a report of three cases and review of literature

et al. 2017

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BackgroundPerforation of the horizontal duodenum is very rare due to the presence in retroperitoneal space. It depicts an unusual clinical picture and is difficult to diagnose, leading to increased morbidity and mortality. The treatment strategies are usually varied and based on small series of cases, literature reviews, and expert opinions.Case presentationHere, we presented three cases of horizontal duodenal perforation in three different clinical processes. The first case, a 30-year-old male patient, presented with abdominal pain and hematemesis after experiencing a physical assault on the previous day. Computed tomography (CT) scan showed rupture of the horizontal duodenum. It was repaired by side-to-side duodenojejunostomy. Postoperatively, he had anastomotic leakage, disseminated intravascular coagulation, and pulmonary failure and recovered after a long hospital stay. The second case, an 81-year-old female, had duodenal perforation with endoscopic coagulation of the bleeding diverticulum. Segmental resection of the duodenum and side-to-side duodenojejunostomy were performed. Postoperatively, there was slight anastomotic leakage, but surgical intervention was not needed. The third case, an 89-year-old female, was a patient with obstructive jaundice due to pancreas head carcinoma, who developed perforation of the horizontal duodenum during endoscopic retrograde cholangiopancreatography (ERCP). After unsuccessful conservative management, duodenojejunostomy at the perforated site and gastric bypass were performed. The postoperative course was uneventful.ConclusionEarly suspicion and investigation is necessary for cases of abdominal injuries. CT scan is the investigation of choice. The management options should be based on the clinical condition of the patient, comorbidities, surgical expertise, existing guidelines, and available resources.

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Damage Control Surgery for Abdominal Trauma

Cited by 7 publications

References 38 publications

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

Modified Whipple on an 18-month-old with traumatic pancreatic transection and duodenal rupture

Management of horizontal duodenal perforation: a report of three cases and review of literature

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