DAMAGE CONTROL FOR ABDOMINAL TRAUMA

Abstract Background Obesity has become a major contributor to the global burden of chronic disease and disability. Understanding the effect of obesity on the incidence of wound infections and other wound complications remains incomplete despite considerable attention to both the growing ‘‘epidemic’’ of obesity and the frequent occurrence of surgical site infection (SSI) after surgical procedures. Damage-control laparotomy specifically has been associated with a higher rate of infectious complications and a lower rate of primary fascial closure in obese patients. Aim of the work The aim of the study is to evaluate the correlation between obesity and surgical site infection (SSI) in patients undergoing exploratory laparotomy after abdominal trauma. Patients and methods A retrospective study performed on obese patients of both genders aged between 18 and 60 years old undergoing exploratory laparotomy after abdominal trauma at the surgery departments of Ain Shams University Hospitals, Al-Bank Al-Ahly Hospital, Al-Mataria Hospital and Al-Salam Hospital, Cairo, Egypt for two years (1st of January 2018 to 1st of January 2020). Patients with infected wounds, receiving antibiotic therapy at the time of injury, those with a known immunodeficiency, who died within 48 hours after injury, who had sustained burn injuries, who underwent surgery at another institution before admission to our hospital were excluded. The rate of 30-day SSI post-operatively among obese and non-obese patients were compared. Statistical analysis was also done. Results Out of 782 patients, only 480 of those patients for whom BMI data were available, 360 (75%) were males and 120 (25%) were females. Out of the 480 patients: 168 patients had BMI more than 30; 114 patients (67.8%) had SSI (P < 0.05), 312 patients had BMI less than 30; 61 patients (19.5%) had SSI. All of the included patients were fulfilling the inclusion and the exclusion criteria. On multivariate analysis, obesity was the strongest predictor of SSI (odds ratio = 1.59; 95% confidence interval, 1.32-1.91) after adjustment for sex and age. Obese patients with SSI compared with the non-obese had longer hospital stays (mean, 9.5 vs 8.1 days, respectively; P < .001) and markedly higher rates of hospital readmission (27.1% vs 6.5%, respectively; P < .001). Conclusion Obesity is considered as one of the risk factors in causing surgical site infection. Thus, this study showed the relation of BMI and obesity with surgical site infection in case of exploratory laparotomy after abdominal trauma.

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Priority Setting in Damage Control Surgery for Multiple Abdominal Trauma Following Resuscitative Endovascular Balloon Occlusion of the Aorta

Journal of Trauma and Injury ◽

10.20408/jti.2020.0040 ◽

2020 ◽

Vol 33 (3) ◽

pp. 181-185

Author(s):

Yoonjung Heo ◽

Seok Won Lee ◽

Dong Hun Kim

Keyword(s):

Abdominal Trauma ◽

Priority Setting ◽

Damage Control ◽

Damage Control Surgery ◽

Balloon Occlusion ◽

Endovascular Balloon Occlusion

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Damage control surgery for abdominal trauma

10.1002/14651858.cd007438.pub2 ◽

2010 ◽

Cited By ~ 11

Author(s):

Roberto Cirocchi ◽

Iosief Abraha ◽

Alessandro Montedori ◽

Eriberto Farinella ◽

Isabella Bonacini ◽

...

Keyword(s):

Abdominal Trauma ◽

Damage Control ◽

Damage Control Surgery

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Abdominal Trauma Revisited

The American Surgeon ◽

10.1177/000313481708301119 ◽

2017 ◽

Vol 83 (11) ◽

pp. 1193-1202 ◽

Cited By ~ 6

Author(s):

David V. Feliciano

Keyword(s):

United States ◽

New York ◽

World War Ii ◽

Abdominal Trauma ◽

Damage Control ◽

Gunshot Wounds ◽

The United States ◽

Operative Approach ◽

Contrast Enhanced Ct ◽

The 1960S

Although abdominal trauma has been described since antiquity, formal laparotomies for trauma were not performed until the 1800s. Even with the introduction of general anesthesia in the United States during the years 1842 to 1846, laparotomies for abdominal trauma were not performed during the Civil War. The first laparotomy for an abdominal gunshot wound in the United States was finally performed in New York City in 1884. An aggressive operative approach to all forms of abdominal trauma till the establishment of formal trauma centers (where data were analyzed) resulted in extraordinarily high rates of nontherapeutic laparotomies from the 1880s to the 1960s. More selective operative approaches to patients with abdominal stab wounds (1960s), blunt trauma (1970s), and gunshot wounds (1990s) were then developed. Current adjuncts to the diagnosis of abdominal trauma when serial physical examinations are unreliable include the following: 1) diagnostic peritoneal tap/lavage, 2) surgeon-performed ultrasound examination; 3) contrast-enhanced CT of the abdomen and pelvis; and 4) diagnostic laparoscopy. Operative techniques for injuries to the liver, spleen, duodenum, and pancreas have been refined considerably since World War II. These need to be emphasized repeatedly in an era when fewer patients undergo laparotomy for abdominal trauma. Finally, abdominal trauma damage control is a valuable operative approach in patients with physiologic exhaustion and multiple injuries.

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New Criteria for Deciding Damage Control Surgery for Severe Abdominal Trauma

Prehospital and Disaster Medicine ◽

10.1017/s1049023x00015302 ◽

2005 ◽

Vol 20 (S2) ◽

pp. S146-S147

Author(s):

K. Mashiko ◽

Y. Sakamoto ◽

H. Matsumoto ◽

K. Takuhiro ◽

Y. Hara ◽

...

Keyword(s):

Abdominal Trauma ◽

Damage Control ◽

Damage Control Surgery ◽

New Criteria

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Damage control surgery in the abdominal trauma

Revista Médica de Minas Gerais ◽

10.5935/2238-3182.20160041 ◽

2016 ◽

Vol 26 ◽

Author(s):

Andressa de Sousa Neves ◽

Patricia Rocha Carneiro ◽

Daniela de Cássia Sampaio Miranda ◽

Hana Elisa Vieira ◽

Wilson Luis Abrantes

Keyword(s):

Abdominal Trauma ◽

Damage Control ◽

Damage Control Surgery

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A case report of blunt liver trauma in times of COVID-19 pandemic

Romanian Journal of Orthopaedic Surgery and Traumatology ◽

10.2478/rojost-2020-0014 ◽

2020 ◽

Vol 3 (2) ◽

pp. 90-94

Author(s):

Vlad Braga ◽

Iulian Slavu ◽

Adrian Tulin ◽

Bogdan Socea ◽

Lucian Alecu

Keyword(s):

Abdominal Trauma ◽

Continuous Monitoring ◽

Damage Control ◽

Liver Parenchyma ◽

Hemodynamic Instability ◽

Liver Trauma ◽

Emergency Laparotomy ◽

Trauma Patients ◽

Accidental Fall ◽

Blunt Liver Trauma

AbstractThe liver is one of the most affected organs in abdominal trauma mostly because of its considerable dimensions, the fragility of the liver parenchyma.We present the case of a 29-year-old patient who sustained an abdominal trauma after an accidental fall from a 3 m height. The patient tested positive at RT-PCR for SARS-CoV-2 at admission, without any symptoms of viral infection. The emergency CT scan revealed a blunt liver trauma with an expanding hematoma (grade III). The patient was initially hemodynamically stable but shortly after admission became unstable and required surgical treatment that initially consisted of damage control and liver packing. Reintervention was decided 36 hours later, after reevaluation unpacking and hepatorrhaphy were done. The postoperative evolution was uneventful. The case indicated the importance of continuous monitoring of the traumatic patient. In liver trauma, hemodynamic instability guarantees an emergency laparotomy. The time of operations in trauma patients with SARS-CoV-2 must be reduced to the maximum both as an objective of damage control and also to minimize the risk of contagion.

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Discussion on the Key Factors for the Treatment of Extremely High-risk Abdominal Trauma Patients With Partial Full-thickness Abdominal Wall Defects

10.21203/rs.3.rs-1078551/v1 ◽

2021 ◽

Author(s):

JiaQing Gong ◽

MingHui Pang ◽

Wei Li ◽

GuoDe Luo ◽

ZhiBing Yuan ◽

...

Keyword(s):

High Risk ◽

Abdominal Wall ◽

Abdominal Trauma ◽

Successful Treatment ◽

Damage Control ◽

Damage Control Surgery ◽

Abdominal Wall Defects ◽

Trauma Patients ◽

Full Thickness ◽

Key Factors

Abstract BackgroundPatients with extremely high-risk abdominal trauma and full-thickness necrosis and defects of the partial abdominal wall are clinically rare, and the treatments for these patients are very difficult and complex . In this study, we will explore the key factors for successful treatment of these patients . MethodsThree patients with extremely high-risk abdominal trauma and partial full-thickness abdominal wall defects were involved in this retrospective study, and one representative case was emphatically reviewed. According to the theory of damage control surgery,the consultation and coordinated treatment of multidisciplinary team(MDT) were involved firstly, then, stepped multiple operations,such as partial perforated small bowel resection, full-thickness abdominal wall defects repair, vacuum sealing drainage (VSD), and wounds skin grafts, were performed, meanwhile, systemic life resuscitation was strengthened. ResultsTwo patients were cured and discharged after 3 and 9 operations respectively. One patient suffered 2 operations and eventually died of lung infection and respiratory failure. ConclusionThe determination and responsibility of surgeons, rational use of damage control theory and multidisciplinary cooperation should be the keys for successful treatment.

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