Impact of Stomach and Colon Injuries on Intra-abdominal Abscess and the Synergistic Effect of Hemorrhage and Associated Injury

Abstract

Gastric injuries are equivalent to colon wounds in their contribution to IAA. Contamination from either organ without associated injury is minimally associated with IAA, but injury to both appears synergistic. The immunosuppressive effects of age and hemorrhage, in addition to significant associated injury, enhance the development of IAA.

Microbiological Profile and Antimicrobial Susceptibility in Surgical Site Infections Following Hollow Viscus Injury

“…[1][2][3][4][5][6][7][8][9][10] There is an extensive body of literature examining the risk factors associated with an SSI following trauma, which include gross contamination by colonic content, advanced age, requirement for blood product transfusion, and concomitant stomach injury. 1,2,[5][6][7]9 Multiple investigations have also attempted to assess the efficacy of various antimicrobial regimens aimed at reducing the incidence of postoperative infections after abdominal surgery. 3,4,[10][11][12][13][14][15][16][17][18][19] A clear understanding of the microbiological profile of SSI after HVI is important for guiding empiric therapy for these injuries.…”

Gastric perforation following blunt abdominal trauma

“…The majority of complications are septic in nature with the reported incidence of intra-abdominal abscesses being up to 24% [9] . In contrast to the fasted patient with a low gastric pH and bacterial load, the fed patient has a higher gastric pH that predisposes to a greater bacterial load with potential to predispose to much contamination and infective complications.…”

“…Presently, helical (spiral) computed tomography (CT) is advocated when there is diagnostic doubt in the setting of haemodynamic stability. The alarm features on CT scan which prompt further intervention (diagnostic peritoneal lavage if single abnormality, laparotomy if several abnormalities) include unexplained intraperitoneal fluid, pneumoperitoneum, bowel wall thickening, mesenteric fat stranding, mesenteric haematoma, extravasation of bowel contents and free blood [9] . Notwithstanding this, clinical vigilance is mandatory as a negative CT scan may miss a bowel perforation in 13% of cases [13] .…”

Penetrating Injuries to the Stomach, Duodenum, and Small Bowel

“…If a gastric perforation is encountered, we recommend that secondary or delayed primary skin closure should be performed in view of the increased risk of surgical site infection. This is particularly true when significant hemorrhage or associated colon injury is present, in which case the rate of intra-abdominal abscess formation may be as high as 24 % [2]. The incidence of wound complications from isolated small bowel injury is relatively low (6 % in a single institution study [3]), and most surgeons recommend proceeding with primary closure in this scenario.…”