Colonic trauma

2.  42 Year Old Male
 Self-inflicted Stab Wound to Right Upper Abdomen
and Left Wrist at 6am
 Brought in by Ambulance at 1500

3.  No Significant Past Medical History Available

4.  Tachycardic (118b/min)
 Conscious
Examination

5.  About 6cm at left mid-forearm
 Muscles and Tendon Exposed
 Non-Arterial Bleeding present
Forearm Wound Examination

6. Abdominal Wound Examination

7. Management?

8.  ATLS Guidelines?
 Wounds?
 E & D?

9.  How are you going to Investigate this patient?
 What’s Next Step of Management?

13.  Consented
 Booked
 Anaesthetist Informed
 Theatre Staff Informed

14. Plan of Surgery?

15.  Decision?
 Operative Findings?
 After Anaesthesia…

16.  What is your Opinion About Surgical Management of
This Patient?

17.  Despite Reports Of Negative Laparotomy In 5 To 27% Of
Abdominal Gunshot Wounds And Up To 53% Of Stab
Wounds, Penetrating Abdominal Injuries Are Still
Predominately Managed With Open Exploration

18.  Complications From Unnecessary Laparotomy Must Be
Weighed Against The Potential Severe Morbidity And
Mortality From Missed Injurie

19. Management of Penetrating Colonic Injuries

20. Colon Injury Scale
American Association for the Surgery of Trauma

21.  Concepts Such As Early Focused Antibiotic Use,
Appropriate Resuscitation, And Damage Control
Techniques Are Now A Mainstay Of Care For Colonic
Injuries

24.  Successful Primary Repair In
 73 To 85% Of Civilian Injuries
 11 To 72% Of Military Injuries.
 Primary Repair
 Safe
 Avoided The Additional Morbidity Associated With Stoma
Construction And Eventual Closure
 Miller P R, Fabian T C, Croce M A. Et Al.Improving Outcomes Following Penetrating Colon Wounds: Application
Of A Clinical Pathway

25.  Ultimate Goal To Avoid
 An Anastomotic Leak
 The High Morbidity

26.  Anastomotic Leak Rates Following The Primary Repair
Of Colonic Wounds In Civilian Trauma Centers Still
Range From 0 To 15%

27.  Severe Faecal Contamination,
 Shock,
 Excessive Blood Loss,
 Multiple Transfusions,
 Concomitant Intraabdominal Organ Injuries, And
 Delayed Presentation Or Time To Surgical Treatment
Risk Factors Associated With
Development Of Anastomotic Leaks
following primary repair in the trauma setting

28.  Technique Used To Repair The Colonic Wall Injury For
Primary Anastomosis?
 NO DIFFERENCE IN OVERALL COLON-RELATED
COMPLICATIONS OR ANASTOMOTIC LEAK RATE
 Demetriades D, Murray J A, Chan L S. et al.Handsewn versus stapled anastomosis in
penetrating colon injuries requiring resection: a multicenter study. J Trauma. 2002;52(1):117–
121

29.  Colon Trauma Management Has Evolved Dramatically
Over The Past Century.
 Through Advancements In Perioperative Care And
Surgical Techniques, Studies Are Now Focusing On
Reducing The Risk For Anastomotic Complications
Conclusion