Epidemiology of modern battlefield colorectal trauma

Glasgow, Sean C.; Steele, Scott R.; Duncan, James E.; Rasmussen, Todd E.

doi:10.1097/ta.0b013e3182754759

Cited by 43 publications

(34 citation statements)

References 14 publications

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“…However, when focused specifically on colorectal trauma, GSWs are the predominant wounding modality. 4,[11][12][13][14]23,24 In the current study, GSW was found to be an independent risk factor for fecal diversion on multivariate analysis. Conversely, blast injury was not found to be an independent risk factor for colostomy.…”

Section: Discussionmentioning

confidence: 88%

“…[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. 10,[14][15][16][17] An initial step toward improving combat casualty care is understanding the wound and patient factors that correlate with colostomy creation.…”

mentioning

confidence: 99%

“…[1][2][3] Although both our understanding of and initial treatment approach to complex polytrauma patients are improving, the ideal management of colon injuries in modern conflicts remains poorly elucidated. 4 Colon trauma, once considered a universally fatal injury, has seen a significant decline in mortality over the last 70 years due to the advancement of antibiotics, blood component resuscitation, and the expeditious repair of injuries to prevent fecal contamination. 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.…”

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confidence: 99%

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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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Section: Discussionmentioning

confidence: 88%

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confidence: 99%

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confidence: 99%

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

Watson¹,

Aden²,

Engel³

et al. 2014

Surgery

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“…On multivariate analysis, significant predictors for stoma creation were rectal involvement (odds ratio (OR) = 2.2, rectum versus left colon; OR = 7.5, rectum versus right colon), gunshot wounds (OR = 3.4), Injury Severity Score ≥ 16 (OR, 1.7), and damage control surgery (OR, 1.6) [17]. The results of Glasgow et al, which present 977 coalition military personnel registered during eight years with colorectal injuries, should be noted [18]. The authors found that mortality was significantly higher for rectal injuries managed without fecal diversion (10.8% versus 3.7%, p < 0.0001) [18].…”

Section: Discussionmentioning

confidence: 99%

Complex Perineal Trauma with Anorectal Avulsion

Cruceru

Negoi

Păun

et al. 2016

Case Reports in Surgery

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Introduction. The objective of this case report is to illustrate a severe perineal impalement injury, associated with anorectal avulsion and hemorrhagic shock. Results. A 32-year-old male patient was referred to our hospital for an impalement perineal trauma, associated with complex pelvic fracture and massive perineal soft tissue destruction and anorectal avulsion. On arrival, the systolic blood pressure was 85 mm Hg and the hemoglobin was 7.1 g/dL. The patient was transported to the operating room, and perineal lavage, hemostasis, and repacking were performed. After 12 hours in the Intensive Care Unit, the abdominal ultrasonography revealed free peritoneal fluid. We decided emergency laparotomy, and massive hemoperitoneum due to intraperitoneal rupture of pelvic hematoma was confirmed. Pelvic packing controlled the ongoing diffuse bleeding. After 48 hours, the relaparotomy with packs removal and loop sigmoid colostomy was performed. The postoperative course was progressive favorable, with discharge after 70 days and colostomy closure after four months, with no long-term complications. Conclusions. Severe perineal injuries are associated with significant morbidity and mortality. Their management in high volume centers, with experience in colorectal and trauma surgery, allocating significant human and material resources, decreases the early mortality and long-term complications, offering the best quality of life for patients.

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“…Glasgow et al [26] investigated 977 CRI cases and found that diversion rate in rectal injuries was approximately twice that in colon injuries. Similarly, rates in the present study were 90% and 36% in rectum and colon injuries, respectively.…”

Section: Discussionmentioning

confidence: 99%