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Open Access

Evolution of the operative management of colon trauma

John P Sharpe, Louis J Magnotti, Timothy C Fabian, Martin A Croce
DOI: 10.1136/tsaco-2017-000092 Published 31 July 2017
John P Sharpe
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Louis J Magnotti
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Timothy C Fabian
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Martin A Croce
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee, USA
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Article Figures & Data

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  • Figure 1
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    Figure 1

    Defined management algorithm for penetrating colon injuries. PRBCs, packed red blood cells.

  • Figure 2
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    Figure 2

    Colon-related morbidity and mortality after implementation of a defined management algorithm for penetrating colon injuries. The percentage of abscess formation, suture line failure and mortality is represented along the vertical axis. The solid line represents abscess formation, the dots represent suture line failure and the dashes represent mortality.

Tables

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  • Table 1

    Stewart et al: risk factors for suture line failure

    Resection + anastomosisSuture line failure (%)Death (%)
    All patients (n=43)1412
    PRBCs transfusion >6 units3333
    Medical illness7550
    Combined high risk4233
    • PRBCs, packed red blood cells.

  • Table 2

    Adjusted ORs for suture line failure, colon-related morbidity and colon-related mortality in all patients based on anatomic location of injury

    Suture line failureColon-related morbidityColon-related mortality
    Adjusted OR95% CIAdjusted OR95% CIAdjusted OR95% CI
    Ascending0.960.25 to 3.691.390.78 to 2.480.600.06 to 5.92
    Transverse0.160.02 to 1.340.680.38 to 1.180.650.06 to 6.53
    Descending3.360.91 to 12.421.310.71 to 2.420.580.06 to 5.52
    Sigmoid1.370.25 to 7.390.800.35 to 1.815.480.67 to 45.1
  • Table 3

    Comparison of patients that underwent delayed anastomosis managed according to the algorithm versus patients not managed according to the algorithm

    No algorithmAlgorithmp
    n1923
    Age (years)39430.45
    Comorbidity (%)1100.20
    Male (%)63740.52
    Injury severity score30210.01
    Intra-op PRBCs (units)15.64.1<0.001
    Admission Shock Index1.30.80.002
    Admission BE (mEq/L)−10.6−4.70.007
    Suture line failure (%)3240.03
    Colon-related morbidity (%)58220.03
    Colon-related mortality (%)1100.20
    • Admission Shock Index, admission systolic blood pressure/admission heart rate.

    • Abd-AIS , Abdominal Abbreviated Injury Scale; BE, base excess; PRBCs, packed red blood cells.

  • Table 4

    Comparison of suture line failure across series evaluating delayed anastomosis after abbreviated laparotomy

    nSuture line failure (%)
    Miller et al 59 110
    Weinberg et al 60 3312.1
    Kashuk et al 61 2916
    Ott et al 62 4427.3
    Vertrees et al 63 1010
    Ordonez et al 64 277.4
    Georgoff et al 65 2821
    Burlew et al 66 6020
    Sharpe et al 67 4216.7
    No algorithm1932
    Algorithm234
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Evolution of the operative management of colon trauma
John P Sharpe, Louis J Magnotti, Timothy C Fabian, Martin A Croce
Trauma Surg Acute Care Open Jul 2017, 2 (1) e000092; DOI: 10.1136/tsaco-2017-000092

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Evolution of the operative management of colon trauma
John P Sharpe, Louis J Magnotti, Timothy C Fabian, Martin A Croce
Trauma Surg Acute Care Open Jul 2017, 2 (1) e000092; DOI: 10.1136/tsaco-2017-000092
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Evolution of the operative management of colon trauma
John P Sharpe, Louis J Magnotti, Timothy C Fabian, Martin A Croce
Trauma Surgery & Acute Care Open Jul 2017, 2 (1) e000092; DOI: 10.1136/tsaco-2017-000092
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  • Article
    • Abstract
    • Introduction
    • History of military and civilian experience
    • Destructive colon wounds
    • Colon wound location
    • Blunt colon wounds
    • Abbreviated laparotomy
    • Conclusions
    • Footnotes
    • References
  • Figures & Data
  • eLetters
  • Info & Metrics
  • PDF

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