Article Commentary: Evolving Colon Injury Management: A Review

2013 ◽  
Vol 79 (2) ◽  
pp. 119-127 ◽  
Author(s):  
Cpt Lauren T. Greer ◽  
Maj Suzanne M. Gillern ◽  
Maj Amy E. Vertrees
Keyword(s):  
Wide Spectrum ◽  
Primary Repair ◽  
Damage Control ◽  
Primary Anastomosis ◽  
Penetrating Trauma ◽  
Management Options ◽  
The Past ◽  
Non Destructive ◽  
Historical Management ◽  
Colon Injuries

The colon is the second most commonly injured intra-abdominal organ in penetrating trauma. Management of traumatic colon injuries has evolved significantly over the past 200 years. Traumatic colon injuries can have a wide spectrum of severity, presentation, and management options. There is strong evidence that most non-destructive colon injuries can be successfully managed with primary repair or primary anastomosis. The management of destructive colon injuries remains controversial with most favoring resection with primary anastomosis and others favor colonic diversion in specific circumstances. The historical management of traumatic colon injuries, common mechanisms of injury, demographics, presentation, assessment, diagnosis, management, and complications of traumatic colon injuries both in civilian and military practice are reviewed. The damage control revolution has added another layer of complexity to management with continued controversy.

Outcomes of Primary Repair and Primary Anastomosis in War-Related Colon Injuries

2009 ◽  
Vol 66 (5) ◽  
pp. 1286-1293 ◽  
Author(s):  
Amy Vertrees ◽  
Matthew Wakefield ◽  
Chris Pickett ◽  
Lauren Greer ◽  
Abralena Wilson ◽  
...  
Keyword(s):  
Primary Repair ◽  
Primary Anastomosis ◽  
Colon Injuries

scholarly journals Lessons learnt from the Pietermaritzburg experience with damage control laparotomy for trauma

2018 ◽  
Vol 164 (6) ◽  
pp. 428-431
Author(s):  
Ross D Weale ◽  
V Y Kong ◽  
J M Blodgett ◽  
J Buitendag ◽  
A Ras ◽  
...  
Keyword(s):  
Trauma Registry ◽  
Primary Repair ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Physiological Parameters ◽  
Modern Concept ◽  
Damage Control Laparotomy ◽  
Trauma Service ◽  
The Mean

IntroductionThe modern concept of damage control surgery (DCS) for trauma was first introduced less than three decades ago. This audit aims to describe the spectrum and outcome of patients requiring DCS, to benchmark our experience against that reported from other centres and countries and to distil the pertinent teaching lessons from this experience.MethodsAll patients over the age of 15 years undergoing a laparotomy for trauma over the period from December 2012 to July 2016 were retrieved from the trauma registry of the Pietermaritzburg Metropolitan Trauma Service, South Africa. Physiological parameters and visceral injuries were assessed. Statistical analysis was performed using STATA V.15.0.ResultsA total of 562 patients underwent trauma laparotomy during the period under review. The mechanism was penetrating trauma in 81% of cases (453/562). A great proportion of trauma victims were male (503/562, 90%), with a mean age of 29.5±10.8. A total of 99 of these (18%) had a DCS procedure versus 463 (82%) non-DCS. Out of the 99 who required DCS, there were 32 mortalities (32%). The mean physiological parameters for the DCS patient demonstrated acidosis (pH 7.28±0.15) with a raised lactate (5.25 mmol/L±3.71). Our primary repair rates for enteric injuries were surprisingly high.ConclusionJust under 20% of trauma laparotomies require DCS. In this cohort of patients, the mortality rate is just under one-third. Further attention must be paid to refining the appropriate indications for DCS as the margin for error in such a cohort is very small and poor decision-making is difficult to correct. The major lesson from this analysis is that the decision to perform DCS must be made early and communicated appropriately to all those managing the patient.

scholarly journals Damage control in penetrating duodenal trauma: less is better

2021 ◽  
Vol 52 (2) ◽  
pp. e4104509
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Mauricio Millan ◽  
Yaset Caicedo ◽  
Natalia Padilla ◽  
...  
Keyword(s):  
Surgical Management ◽  
Primary Repair ◽  
Damage Control ◽  
Treatment Algorithm ◽  
Surgical Techniques ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Trauma Patients ◽  
Severe Injuries ◽  
Duodenal Injuries

The overall incidence of duodenal injuries in severely injured trauma patients is between 0.2 to 0.6% and the overall prevalence in those suffering from abdominal trauma is 3 to 5%. Approximately 80% of these cases are secondary to penetrating trauma which are commonly associated with vascular and adjacent organ injuries. Therefore, defining the best surgical treatment algorithm remains controversial. Mild to moderate duodenal trauma is currently managed via primary repair and simple surgical techniques. However, severe injuries have required complex surgical techniques without significant favorable outcomes and consequential increase in the rates of mortality. The aim of this article is to delineate the experience in the surgical management of penetrating duodenal injuries via the creation of a practical and effective algorithm that includes basic principles of damage control surgery which sticks to the philosophy of “Less is Better”. Surgical management of all penetrating duodenal trauma should always default when possible to primary repair. When confronted with a complex duodenal injury, hemodynamic instability and/or significant associated injuries then the default should be damage control surgery. Definitive reconstructive surgery should be postponed until the patient has been adequately resuscitated and the diamond of death has been corrected.

scholarly journals Primary Anastomosis versus Colostomy in Patients with Penetrating Colonic Injuries; A Comparative Study

2021 ◽  
Vol 15 (7) ◽  
pp. 1840-1842
Author(s):  
Khalid Mahmood ◽  
Allah Nawaz ◽  
Ahmad Hassan Khan ◽  
Asad Rizwan Rana ◽  
Rażą Farrukh ◽  
...  
Keyword(s):  
Sample Size ◽  
Primary Repair ◽  
Primary Anastomosis ◽  
Complication Rates ◽  
Abdominal Abscess ◽  
Significant Difference ◽  
Lower Complication ◽  
Ethical Approval ◽  
Blotting Technique ◽  
Colon Injuries

Background: Penetrating colon injuries treatment has been a controversial topic of discussion in medical literature. The literature shows that randomized trials comparing primary repair versus bypass showed no significant difference in complication rates between the two groups. While other trials comparing complication rates between the two groups showed that the primary repair has lower complication rates as compared to the colostomy. Methodology: Randomized control trail was conducted in six months of duration from 1stJanuary 2020 to 31stDecember 2020in surgical unit of DHQ Teaching Hospital / SMC (UOS), Sargodha. After taking Ethical approval from the hospital, the study was conducted on 300 patients sample size calculated through open Epi sample size calculator with margin of error 5% and confidence interval 95%. Randomized blotting technique was used for randomization to overcome biasness. Results: Group 01 of primary anastomosis had 97 (64.67%) males and 53 (35.33%) females while group 02 of colostomy had 92 (66.34%) males and 58 (33.66%) females. complications intra-abdominal abscess was analyzed between both groups. In group 01 primary anastomosis, only 4 (2.66%) patients develop intra-abdominal abscess while in rest of patients i.e. 146(97.34%) showed efficacy to primary anastomosis. In group 02 of colostomy, 27 (18%) patients develop intra-abdominal abscess while rest of patients i.e. 123(82%) patients showed efficacy towards colostomy. Conclusion: In penetrating colon injuries, anastomosis showed more efficacy, safe to use and excellent results on the basis of post-operative complications as compared to colostomy. Keywords: Primary anastomosis, defunctioning in colostomy, penetrating colonic injuries, effectiveness

Primary repair of civilian colon injuries is safe in the damage control scenario

Surgery ◽  
2009 ◽  
Vol 146 (4) ◽  
pp. 663-670 ◽  
Author(s):  
Jeffry L. Kashuk ◽  
C. Clay Cothren ◽  
Ernest E. Moore ◽  
Jeffrey L. Johnson ◽  
Walter L. Biffl ◽  
...  
Keyword(s):  
Primary Repair ◽  
Damage Control ◽  
Colon Injuries

scholarly journals Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?

2021 ◽  
Vol 52 (2) ◽  
pp. e4114425
Author(s):  
Carlos Alberto Ordoñez ◽  
Michael Parra ◽  
Yaset Caicedo ◽  
Natalia Padilla ◽  
Edison Angamarca ◽  
...  
Keyword(s):  
Surgical Management ◽  
Large Bowel ◽  
Damage Control ◽  
Primary Anastomosis ◽  
Penetrating Trauma ◽  
Damage Control Surgery ◽  
Bowel Injury ◽  
Penetrating Injuries ◽  
Hollow Viscus ◽  
Injury Repair

Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.

scholarly journals Colon Trauma: Evidence-Based Practices

2017 ◽  
Vol 31 (01) ◽  
pp. 011-016 ◽  
Author(s):  
Ryo Yamamoto ◽  
Mark Muir ◽  
Alicia Logue
Keyword(s):  
Damage Control ◽  
Primary Anastomosis ◽  
Scientific Evidence ◽  
Damage Control Surgery ◽  
Operative Management ◽  
Fascial Closure ◽  
Hollow Viscus ◽  
Management Algorithm ◽  
Increased Risk ◽  
Colon Injuries

AbstractColon injury is not uncommon and occurs in about a half of patients with penetrating hollow viscus injuries. Despite major advances in the operative management of penetrating colon wounds, there remains discussion regarding the appropriate treatment of destructive colon injuries, with a significant amount of scientific evidence supporting segmental resection with primary anastomosis in most patients without comorbidities or large transfusion requirement. Although literature is sparse concerning the management of blunt colon injuries, some studies have shown operative decision based on an algorithm originally defined for penetrating wounds should be considered in blunt colon injuries. The optimal management of colonic injuries in patients requiring damage control surgery (DCS) also remains controversial. Studies have recently reported that there is no increased risk compared with patients treated without DCS if fascial closure is completed on the first reoperation, or that a management algorithm for penetrating colon wounds is probably efficacious for colon injuries in the setting of DCS as well.

scholarly journals The management of colonic trauma in the damage control era

2017 ◽  
Vol 99 (1) ◽  
pp. 76-81 ◽  
Author(s):  
B Shazi ◽  
JL Bruce ◽  
GL Laing ◽  
B Sartorius ◽  
DL Clarke
Keyword(s):  
Primary Repair ◽  
Damage Control ◽  
Penetrating Trauma ◽  
Gunshot Wounds ◽  
Study Data ◽  
Colonic Injury ◽  
Trauma Service ◽  
Repeat Operation ◽  
Optimal Approach ◽  
Colonic Trauma

INTRODUCTIONThe purpose of this study was to audit our current management of colonic trauma, and to review our experience of colonic trauma in patients who underwent initial damage control (DC) surgery.METHODSAll patients treated for colonic trauma between January 2012 and December 2014 by the Pietermaritzburg Metropolitan Trauma Service were included in the study. Data reviewed included mechanism of injury, method of management (primary repair [PR], primary diversion [PD] or DC) and outcome (complications and mortality rate).ResultsA total of 128 patients sustained a colonic injury during the study period. Ninety-seven per cent of the injuries were due to penetrating trauma. Of these cases, 56% comprised stab wounds (SWs) and 44% were gunshot wounds (GSWs). Management was by PR in 99, PD in 20 and DC surgery in 9 cases. Among the 69 SW victims, 57 underwent PR, 9 had PD and 3 required a DC procedure. Of the 55 GSW cases, 40 were managed with PR, 9 with PD and 6 with DC surgery. In the PR group, there were 16 colonic complications (5 cases of breakdown and 11 of wound sepsis). Overall, nine patients (7%) died.CONCLUSIONSPR of colonic trauma is safe and should be used for the majority of such injuries. Persistent acidosis, however, should be considered a contraindication. In unstable patients with complex injuries, the optimal approach is to perform DC surgery. In this situation, formal diversion is contraindicated, and the injury should be controlled and dropped back into the abdomen at the primary operation. At the repeat operation, if the physiological insult has been reversed, then formal repair of the colonic injury is acceptable.

Impact of microRNAs on molecular epidemiology

2011 ◽  
Vol 152 (16) ◽  
pp. 633-641 ◽  
Author(s):  
Katalin Gőcze ◽  
Katalin Gombos ◽  
Gábor Pajkos ◽  
Ingrid Magda ◽  
Ágoston Ember ◽  
...  
Keyword(s):  
Functional Analysis ◽  
Cancer Research ◽  
Molecular Epidemiology ◽  
Wide Spectrum ◽  
Translation Regulation ◽  
Rna Sequences ◽  
Serum Mirna ◽  
The Past ◽  
Non Coding Rna ◽  
Free Serum

Cancer research concerning short non-coding RNA sequences and functionally linked to RNA interference (RNAi) have reached explosive breakthrough in the past decade. Molecular technology applies microRNA in extremely wide spectrum from molecular tumor prediction, diagnostics, progression monitoring and prevention. Functional analysis of tissue miRNA and cell-free serum miRNA in posttranscription and translation regulation innovated and restructured the knowledge on the field. This review focuses on molecular epidemiology and primary prevention aspects of the small non-coding RNA sequences. Orv. Hetil., 2011, 152, 633–641.

Recent Advances in Therapeutic Applications of Bisbenzimidazoles

2020 ◽  
Vol 16 (4) ◽  
pp. 454-486 ◽  
Author(s):  
Smita Verma ◽  
Vishnuvardh Ravichandiran ◽  
Nihar Ranjan ◽  
Swaran J.S. Flora
Keyword(s):  
Heterocyclic Compounds ◽  
Wide Spectrum ◽  
Dna Recognition ◽  
Present Review ◽  
Pharmacological Activities ◽  
Structural Motifs ◽  
Therapeutic Applications ◽  
The Past ◽  
Recent Advances

Nitrogen-containing heterocycles are one of the most common structural motifs in approximately 80% of the marketed drugs. Of these, benzimidazoles analogues are known to elicit a wide spectrum of pharmaceutical activities such as anticancer, antibacterial, antiparasitic, antiviral, antifungal as well as chemosensor effect. Based on the benzimidazole core fused heterocyclic compounds, crescent-shaped bisbenzimidazoles were developed which provided an early breakthrough in the sequence-specific DNA recognition. Over the years, a number of functional variations in the bisbenzimidazole core have led to the emergence of their unique properties and established them as versatile ligands against several classes of pathogens. The present review provides an overview of diverse pharmacological activities of the bisbenzimidazole analogues in the past decade with a brief account of its development through the years.

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