Primary Repair or Fecal Diversion for Colorectal Injuries After Blast: A Medical Review

Abstract

Blast injury is a frequent cause of injury during armed conflicts, and the force of a blast can cause closed colorectal injury and perforation.1 After identification of a blast-related colorectal injury, the surgical options are primary repair or fecal diversion with the option for secondary repair. This structured review was conducted to determine which patients could be treated with primary repair (PR) or with fecal diversion. The review method followed the Prisma Statement method for medical systematic review. All data from the relevant articles were collected in a single database. Articles took into account wars in Bosnia, Iraq and Afghanistan from January 1993 through November 2012. The review was limited due to lack of reported data, hence qualitative analysis was the main review method. The review showed that for patients who do not have associated intra-abdominal injuries (diaphragm, stomach, pancreas, spleen, or kidney) or hemodynamic instability, PR did not result in an increase of complications or mortality.

Characteristics of Combat-Associated Small Bowel Injuries

“…A review of studies examining the surgical management of colorectal injuries after combat-associated blast injury found diversion rates of 0-78% (mean 49.5%) with no significant differences in mortality or complications between primary repair and diversion. 6 Another review of 133 patients with military colonic injuries from the years 2005-2006 found a diversion rate of 44% compared to primary repair (32%) and damage control (23%). 7 There was not a significant difference in complications between the groups.…”

Trauma Por Onda Explosiva La Mirada Del Cirujano General En La Práctica Civil

“…Ante dicha situación los cirujanos pueden optar por un reparo primario o por una derivación entérica en un primer momento quirúrgico para realizar una reconstrucción cuando el paciente no se encuentre en un estado catabólico. 21,[23][24][25][26] Glasgow et al publican un estudio retrospectivo donde a partir de su experiencia en el manejo de trauma anal durante las guerras de Irak y Afganistán encuentran los siguientes resultados: el 76.1% de las lesiones de ano y recto fueron secundarias a explosiones. El 78.2% de estos pacientes requirieron derivación entérica en la mayoría de los casos por trauma severo de otras estructuras abdominopélvicas asociadas.…”