REVISION BIBLIOGRAFICA

HISTORIA• Al principio de la 1era guerra

Mundial la controversia era efectuar o no laparotomías en lesiones abdominales penetrantes.

• La Cirugía Intestinal no se llevaba a cabo con frecuencia en la practica civil.

• Poco uso de soluciones salinas intravenosas y sangre

• No uso de antibiótico.• No existían técnicas de

evisceración del intestino delgado y movilización colonica.

TRAUMA MATTOX 2004

HISTORIA• Shock preoperatorio• Hemoperitoneo mas 1000cc.• Dos órganos o mas

lesionados intrabdominal.• Contaminación peritoneal.• Tiempo del trauma mayor de

8 horas• Lesión colonica extensa• INDICE TRAUMA

ABDOMINAL• INTENSIDAD DE LESION

COLONICA

TRAUMA MATTOX 2004

LESIONES DE COLON

GRADO DESCRIPCION LESION

I Hematoma

Laceración

Hemat sin desvasculariz

Espesor parcial, sin perforación

II Laceración Menos 50% circunf

III Laceración Mas 50% circunf

IV Laceración Sección del colon

V Laceración Sección con perdida segmentaría tejido

AMERICAN ASSOCIATION FOR THE SURGERY OF TRAUMA

LAPAROTOMIA

LESION DE COLONResección requerida

LAPAROTOMIA ABREVIADA

Lesion ProximalArt. Colica media

Reparacion con sutura

ReseccionIliostomia

Estado del Paciente

ReseccionIliostomia

Colostomia terminal

2da Intervencion

Lesion ProximalArt. Colica Media

ReseccionIliostomia

Colostomia Terminal

Si

No

Si No

Si

No

Bueno

Malo

TRAUMA MATTOX 2004

Miércoles 1 Marzo 2006. Volumen 79 - Número 03 p. 143 - 148   

ESTADO ACTUAL DE LOS TRAUMATISMOS COLORRECTOANALES

Unidad de Coloproctología. Servicio de Cirugía General y Aparato Digestivo. Hospital Universitario Dr. Josep Trueta. Girona. España

Unidad de Coloproctología. Servicio de Cirugía General y Aparato Digestivo. Hospital Universitario Dr. Josep Trueta. Girona. España

Miércoles 1 Marzo 2006. Volumen 79 - Número 03 p. 143 - 148  

ESTADO ACTUAL DE LOS TRAUMATISMOS COLORRECTOANALES

Colonic resection in trauma: colostomy versus anastomosis.Murray JA, Demetriades D, Colson M, Song Z, Velmahos GC, Cornwell EE 3rd, Asensio JA, Belzberg H, Berne TV.Department of Surgery, University of Southern California, Los Angeles County + USC Medical Center, Los Angeles, USA.OBJECTIVES: The management of colonic trauma is well established for simple injuries with primary repair, and ileocolostomy for right-sided injuries that undergo colonic resection. Segmental colon resection for injuries to the left colon can be managed with either an end colostomy or primary anastomosis. A retrospective review was performed to evaluate the outcome and complications associated with colonic resection for trauma to determine the risk factors associated with anastomotic leakage. METHODS: A retrospective review included patients undergoing colonic resection for trauma. The patients were stratified into colostomy, ileocolostomy, and colocolostomy groups. Patient demographics and colon-related complications were collected. Comparison between the colostomy and colocolostomy groups was performed to determine the difference in outcome. The outcome of right-sided colon injuries managed by either an ileocolonic or colocolonic anastomosis was compared. Analysis was performed to identify the factors associated with an increased risk of anastomotic leakage. RESULTS: One hundred forty patients over a 66-month period were included in the analysis. Overall, 41% (57 of 140) of patients developed a colon-related complication; 28% (39 of 140) of patients developed an abscess. Overall, the anastomotic leak rate was 13% (7 of 56) in the colocolostomy group, 4% (2 of 56) in the ileocolostomy group. Right-sided colon injuries managed with a colocolonic anastomosis had a higher incidence of anastomotic leakage than ileocolonic anastomosis, i.e., 14 versus 4% respectively. Of the seven patients who developed a leak from a colocolonic anastomosis, two patients died (29%). Univariate analysis identified an Abdominal Trauma Index Score > or = 25 (p = 0.03) or hypotension in the emergency department (p = 0.001) to be associated with increased risk of developing an anastomotic leak from a colocolonic anastomosis. CONCLUSION: Colonic injuries that are managed with resection are associated with a high complication rate regardless of whether an anastomosis or colostomy is performed. Colonic resection and anastomosis can be performed safely in the majority of patients with severe colonic injury, including injuries to the left colon. For injuries of the right colon, an ileocolostomy has a lower incidence of leakage than a colocolonic anastomosis. For injuries to the left colon, there remains a role for colostomy specifically in the subgroups of patients with a high ATI or hypotension, because these patients are at greater risk for an anastomotic leak. The role of resection and primary anastomosis versus colostomy in colonic trauma requires further investigation.PMID: 10029029 [PubMed - indexed for MEDLINE] 2000

Management of colorectal injuries during operation iraqi freedom: patterns of stoma usage.Duncan JE, Corwin CH, Sweeney WB, Dunne JR, Denobile JW, Perdue PW, Galarneau MR, Pearl JP.Department of Surgery, National Naval Medical Center, Bethesda, Maryland, USA. drjduncan@hotmail.comBACKGROUND: Management of penetrating colorectal injuries in the civilian trauma population has evolved away from diversionary stoma into primary repair or resection and primary anastomosis. With this in mind, we evaluated how injuries to the colon and rectum were managed in the ongoing war in Iraq. METHODS: The records of Operation Iraqi Freedom patients evacuated to National Naval Medical Center (NNMC) from March 2004 until November 2005 were retrospectively reviewed. Patients with colorectal injuries were identified and characterized by the following: (1) injury type; (2) mechanism; (3) associated injuries; (4) Injury Severity Score; (5) levels of medical care involved in patient treatment; (6) time interval(s) between levels of care; (7) management; and (8) outcomes. RESULTS: Twenty-three patients were identified as having either colon or rectal injury. The average ISS was 24.4 (range, 9-54; median 24). On average, patients were evaluated and treated at 2.5 levels of surgically capable medical care (range, 2-3; median 2) between time of injury and arrival at NNMC, with a median of 6 days from initial injury until presentation at NNMC (range, 3-11). Management of colorectal injuries included 7 primary repairs (30.4%), 3 resections with anastomoses (13.0%), and 13 colostomies (56.6%). There was one death (4.3%) and three anastomotic leaks (30%). Total complication rate was 48%. CONCLUSIONS: Based upon injury severity, the complex nature of triage and medical evacuation, and the multiple levels of care involved for injured military personnel, temporary stoma usage should play a greater role in military casualties than in the civilian environment for penetrating colorectal injuries.PMID: 18404073 [PubMed - indexed for MEDLINE] 2008

MANAGEMENT OF ENTEROCUTANEOUS FISTULAS: 30-YEAR CLINICAL EXPERIENCE

Unidad de Coloproctología. Servicio de Cirugía General y Aparato Digestivo. Hospital Universitario Dr. Josep Trueta. Girona. España

Unidad de Coloproctología. Servicio de Cirugía General y Aparato Digestivo. Hospital Universitario Dr. Josep Trueta. Girona. España

MANAGEMENT OF ENTEROCUTANEOUS FISTULAS: 30-YEAR CLINICAL EXPERIENCE

An 11-year experience of enterocutaneous fistula

P. Hollington *, J. Mawdsley, W. Lim, S. M. Gabe, A. Forbes, A. J. WindsorDepartment of Surgery, St Mark's Hospital,

email: P. Hollington (paul.hollington@bigpond.com)

Background:Enterocutaneous fistula has traditionally been associated with substantial morbidity and mortality, related to fluid, electrolyte and metabolic disturbance, sepsis and malnutrition.

Methods:A retrospective review of enterocutaneous fistula in 277 consecutive patients treated over an 11-year period in a major tertiary referral centre was undertaken to evaluate current management practice and outcome.

Results:Most fistulas occurred secondary to abdominal surgery, and a high proportion (52·7 per cent) occurred in association with inflammatory bowel disease. A low rate of spontaneous healing was observed (19·9 per cent). The healing rate after definitive fistula surgery was 82·0 per cent, although more than one attempt was required to achieve surgical closure in some patients. Definitive fistula resection resulted in a mortality rate of 3·0 per cent. In addition, one patient died after laparotomy for intra-abdominal sepsis and an additional 24 patients died from complications of fistulation, giving an overall fistula-related mortality rate of 10·8 per cent.

Conclusion:Early recognition and control of sepsis, management of fluid and electrolyte imbalances, meticulous wound care and nutritional support appear to reduce the mortality rate, and allow spontaneous fistula closure in some patients. Definitive surgical management is performed only after restitution of normal physiology, usually after at least 6 months. Copyright © 2004 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Presented to a meeting of the European Association of Coloproctology, Sitges, Spain, September 2003 and to the Royal Australasian College of Surgeons Annual Scientific

Congress, Melbourne, May 2004; and published in abstract form as Colorectal Dis 2003; 5(Suppl 2): 6 and Aust N Z J Surg 2004; 74(Suppl): A53