Multiple Small Bowel Ligation Compared to Conventional Primary Repair after Abdominal Gunshot Wound with Haemorrhagic Shock

Abstract

Aims: the aim of this study was to evaluate the effects of early rapid control of multiple bowel perforations on cardiovascular function in combined abdominal missile trauma and haemorrhagic shock compared with conventional surgery.Methods: eighteen anesthetised pigs were injured with a standardised abdominal missile trauma. the animals were bled to a mean arterial pressure of 50 mm hg for 30 minutes, after which they were resuscitated and had laparotomy.t hey were divided into conventional surgery group (n=9) with primary resection and anastomosis of bowel injuries and early rapid multiple bowel ligation group (n =9). repeated measurement analysis of variance was used for analysis.Results: there was profound hypotension, reduced cardiac output, increased vascular resistance and lactic acidaemia in both groups. lactic acidaemia persisted longer in the early rapid multiple bowel ligation group. there were no significant differences in mean arterial pressure, cardiac output ,stroke volume or systemic vascular resistance between the groups. the mean operation time was significantly shorter in the early rapid multiple bowel ligation group (13.3 (1.5) (seM) minutes, compared with 116.4 (1.74) (seM) minutes in the conventional surgery group, p =<0.001).Conclusions: damage control principles have shortened the operating time in our model but did not improve the cardiovascular function and caused more lactic acidaemia than conventional repair.

Management of war-related vascular injuries: experience from the second gulf war

“…Simple damage control surgery methods can reduce the operating time in mass casualty situations [19,20]. Rasmussen et al, have used temporary vascular shunts in 30 extremities as a damage control adjunct in the Iraq war, especially for major proximal vascular injuries [21].…”

A novel method for multiple bowel injuries: a pilot canine experiment

“…Currently, damage control surgery is to carry out ligation of severed/injuried GI tract [4, 7, 8]. Aggravated abdominal cavity contamination and bleeding can be easily controlled; however, continuing loss of fluids from the vascular compartment to the interstitial and third spaces leads to hemodynamic imbalance [11].…”

“…Primary anastomosis could be hazardous because of the prolonged operation time and compromised hemodynamic conditions [4–7]. In this regard, temporally reconnecting transected intestines restored the continuity and the function of the GI tract, as evidenced by radiographic examination at 48 h after the reconnection.…”

“…In such cases, management of the GI tract injury is limited to the control of sepsis and hemorrhage [4–8]. Damaged intestines are excised, and the ends are simply ligated to prevent further contamination of the peritoneal cavity.…”

What′s new in emergencies, trauma and shock? Mapping and managing missile injuries

“…Simple damage control surgery methods can reduce the operating time in mass casualty situations. [910] Rasmussen et al , have used temporary vascular shunts in 30 extremities as a damage control adjunct in the Iraq war, especially for major proximal vascular injuries. [11] Local thrombectomy was performed and regional heparin was administered in these cases followed by a fasciotomy, There were no shunt related complications, 86% were patent and only 7% needed early amputation.…”