WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment

Smyth, Luke; Bendinelli, Cino; Lee, Nick; Reeds, Matthew G.; Loh, Eu Jhin; Amico, Francesco; Balogh, Zsolt J.; Saverio, Salomone Di; Weber, Dieter; Broek, Richard Peter ten; Abu‐Zidan, Fikri M.; Campanelli, G.; Beka, Solomon Gurmu; Chiarugi, Massimo; Shelat, Vishal G; Tan, Edward; Moore, Ernest E.; Bonavina, Luigi; Latifi, Rifat; Hecker, Andreas; Khan, Jim; Coimbra, Raúl; Tebala, Giovanni Domenico; Søreide, Kjetil; Wani, Imtiaz; Inaba, Kenji; Kirkpatrick, Andrew W.; Koike, Kazuhiko; Sganga, Gabriele; Biffl, Walter L.; Chiara, Osvaldo; Scalea, Thomas M.; Fraga, Gustavo Pereira; Peitzman, Andrew B.; Catena, Fausto

doi:10.1186/s13017-022-00418-y

Cited by 49 publications

(49 citation statements)

References 119 publications

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“…The possible reason might be that low hemoglobin concentration reduces the oxygen tension in the wound site and increases the risk of SSI by compromising the activity of blood cells such as macrophages and delaying the process of infection healing (32,33) Those patients admitted to the intensive care unit had 21.3 times higher odds of death as compared to those who were not admitted to the intensive care unit. In the guidelines of the World Society of Emergency Surgery (WSES), admission to the ICU is recommended for the management of penetrating abdominal trauma (34). However, in the present study, ICU admission was found as a risk factor.…”

Section: Characteristicscontrasting

confidence: 70%

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

et al. 2022

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BackgroundPenetrating abdominal injury (PAI) is a public health problem and accounts for significant mortality and disability in both developing and developed countries. It often causes damage to internal organs, resulting in shock and infection. In this study, we assessed the outcomes of PAI and factors associated with post-surgical outcomes including surgical site infection (SSI) and in-hospital death.MethodsAn institution-based cross-sectional study was conducted from 15 January to January 30, 2020, using a standard checklist to review the clinical charts of patients who presented to Hiwot Fana Specialized University Hospital (HFSUH) with PAI and underwent laparotomy between January 2015 and September 2019. Descriptive statistics were used to describe the characteristics of patients, and odds ratios (ORs) with a 95% confidence interval (CI) were reported for factors included in binary logistic regression. The statistical significance was declared at a P-value <0.05.ResultsA total of 352 charts of patients with PAI were reviewed. A majority of them (84.9%) were males and the mean age was 26.5 years. The anterior abdomen was the most common site of injury, accounting for 285 patients (81%), 329 patients (93.5%) suffered organ injury, 204 (62%) had a single organ injury, and 125 (38%) had more than one organ injury. The leading injured organs were small intestines 194 (55.1%), followed by the colon 88 (25%) and liver 40 (11.4%). The magnitude of SSI and hospital death was 84 (23.9%) and 12 (3.4%), respectively. Patients above 45 years of age (AOR = 2.9, 95% CI: 1.2, 9.2), with fluid collection (AOR = 2.7, 95% CI: 1.2, 5.9), colostomy (AOR = 3.9, 95% CI: 1.9, 7.8), body temperature >37.5 °C (AOR = 3.8,95% CI:1.9,7.6), and Hgb < 10 mg/dl (AOR = 7.4, 95% CI: 3.4,16.1) had a higher likelihood of SSI. Those patients admitted to the intensive care unit (AOR = 21.3, 95% CI: 1.1, 412.3) and who underwent damage control surgery (AOR = 9.6, 95% CI: 1.3, 73.3) had a higher likelihood of mortality.ConclusionsSSI and death among patients with PAI were high. Age, fluid collection, colostomy, body temperature, and hemoglobin level were statistically associated with SSI, and intensive care unit and damage control surgery were statistically associated with death. Therefore, health professionals working in surgical wards should consider these factors to alleviate SSI and prevent death. Broadly speaking, the guidelines of the World Society of Emergency Surgery (WSES) should consider these factors in their recommendations.

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Section: Characteristicscontrasting

confidence: 70%

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

et al. 2022

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“…Other reports have, however, indicated a wide range in negative laparotomy incidences ranging from 6 to 36% [7,41,42,45,[49][50][51][52][53][54][55]. A further analysis of the negative laparotomy patients revealed that 77% of these were operated solely due to evidence of peritoneal penetration with signs of associated injury, a protocol that remains debatable and not supported by neither the Eastern Association of Trauma (EAST), Western Trauma Association (WTA) or the World Society of Emergency Surgery guidelines [56][57][58].…”

Section: Discussionmentioning

confidence: 99%

A characterization of trauma laparotomies in a scandinavian setting: an observational study

Bentin

Possfelt-Møller

Svenningsen

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background Despite treatment advances, trauma laparotomy continuous to be associated with significant morbidity and mortality. Most of the literature originates from high volume centers, whereas patient characteristics and outcomes in a Scandinavian setting is not well described. The objective of this study is to characterize treatments and outcomes of patients undergoing trauma laparotomy in a Scandinavian setting and compare this to international reports. Methods A retrospective study was performed in the Copenhagen University Hospital, Rigshospitalet (CUHR). All patients undergoing a trauma laparotomy within the first 24 h of admission between January 1st 2019 and December 31st 2020 were included. Collected data included demographics, trauma mechanism, injuries, procedures performed and outcomes. Results A total of 1713 trauma patients were admitted to CUHR of which 98 patients underwent trauma laparotomy. Penetrating trauma accounted for 16.6% of the trauma population and 66.3% of trauma laparotomies. Median time to surgery after arrival at the trauma center (TC) was 12 min for surgeries performed in the Emergency Department (ED) and 103 min for surgeries performed in the operating room (OR). A total of 14.3% of the procedures were performed in the ED. A damage control strategy (DCS) approach was chosen in 18.4% of cases. Our rate of negative laparotomies was 17.3%. We found a mortality rate of 8.2%. The total median length of stay was 6.1 days. Conclusion The overall rates, findings, and outcomes of trauma laparotomies in this Danish cohort is comparable to reports from similar Western European trauma systems.

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“…Sensitive CT-Befunde wie freie Flüssigkeit ohne Verletzung eines parenchymatösen Organs, pathologische Kontrastmittelaufnahme der Darmwand oder eine mesenteriale Imbibierung können zur Entscheidungsfindung beitragen, sollten jedoch nicht alleinige Kriterien sein. Um die insgesamt eingeschränkte Sensitivität des CTs zu erhöhen, wurden Scoring-Systeme etabliert, die durch Kombination der vorgenannten Befunde die Sensitivität und Spezifität erhöhen können 15 .…”

Section: Therapieunclassified

“…Insbesondere bei Dünndarmverletzungen ist aufgrund der guten Heilungstendenz mit Insuffizienzraten von 3% die Anastomose der Diskontinuitätsresektion vorzuziehen. Bei Kolonverletzungen steigt jedoch die Insuffizienzrate, je weiter distal die Anastomose angelegt wird, auf bis zu 50% 15 . Auch die verzögerte Anlage der Anastomose im Rahmen der Zweitoperation sowie das offene Abdomen ist mit erhöhten Insuffizienzraten assoziiert.…”

Section: Therapieunclassified

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Das Abdominaltrauma

Vergote¹,

Diemers²,

Gebhard³

et al. 2022

Allgemein- und Viszeralchirurgie up2date

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WSES guidelines on blunt and penetrating bowel injury: diagnosis, investigations, and treatment

Cited by 49 publications

References 119 publications

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

Treatment outcomes of penetrating abdominal injury requiring laparotomy at Hiwot Fana Specialized University Hospital, Harar, Ethiopia

A characterization of trauma laparotomies in a scandinavian setting: an observational study

Das Abdominaltrauma

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