Reconstructive Surgery of the Colon in Soldiers Injured in Vietnam

Aldrete, Joaquín S.; Hendricks, D.; Dimond, Francis C.

doi:10.1097/00000658-197012000-00013

Cited by 14 publications

(4 citation statements)

References 7 publications

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“…It should be noted that this is in stark contrast with previous conflicts, where diversion approached nearly 100%. 2,3 In this context, the current study documents the evolving trends in the contemporary management of wartime colorectal injuries and will serve as a benchmark for surgeons in future armed conflicts. Initial reports of wounding patterns from OIF and OEF found blast injuries were the most common mechanism of injury.…”

Section: Discussionmentioning

confidence: 99%

“…Although the modern medical literature supports the practice of primary repair of colon and rectal injuries in civilian trauma patients, the management of wartime colon and rectal injuries has primarily consisted of fecal diversion with colostomy. [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.…”

mentioning

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: 99%

mentioning

confidence: 99%

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

Watson¹,

Aden²,

Engel³

et al. 2014

Surgery

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“…This center was responsible for final and definitive care of the injured soldiers, as well as determining which could be returned to duty. Aldrete and colleagues 22 reported on the reconstruction of 50 casualties who had sustained colon injuries in Vietnam from January 1967 to November 1968. All suffered additional injuries, 86% of which were extraabdominal.…”

Section: Vietnam Warmentioning

confidence: 99%

The history of military colorectal trauma management

Perry

Brooks

Muskat

2004

Seminars in Colon and Rectal Surgery

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“…Eine Vermindernug der Morbiditäts-und Letalitätsrate kann im wesentlichen auf eine verbesserte Logistik hinsichtlich des Transports der Verletzten vom Verwundungsort bis ins Krankenhaus und der modernen Evakuationslehre zurückgeführt werden [2].…”

Section: Diskussionunclassified