OBSERVATIONAL STUDY OF ETIOLOGY AND OUTCOME IN HOLLOW VISCUS PERFORATION

Background: Gastrointestinal perforation is a common abdominal emergency having a high morbidity and mortality. Missed diagnosis and late intervention are frequent causes of increased morbidity and mortality especially in patients who survive the initial phase of insult. Diagnosis and treatment of gastrointestinal perforation remains a formidable problem in our country. Aim & Objevtives: To compare certain common etiologies and their outcomes in the following diseases and sites respectively Acid Peptic Disease–Duodenal/Gastric Typhoid- Ileal Diverticulitis-Colon Trauma-Any Part Retrospec Methods: tive observational study of 50 Operated Patients done in Government Medical College Surat during period of September 2019 to December 2020 According to Inclusion and Exclusion Criteria. Data is analysed using descriptive statistics (Percentage, Proportions). Among 50 cases of hollow viscus Results & Conclusion: perforation, Peptic perforation was common (33 out of 50 cases). Next being Ileal perforation. Jejunum was common site of perforation in blunt abdominal trauma. Peptic Perforations are more commonly seen in 40-60yrs of age group with alcohol and smoking as their addiction, with worker as occupation. Typhoid Perforations are more commonly seen in 20-40yrs of age group. In this study except for wound dehiscence in 4 cases which needed secondary suturing, no major morbidity noted. 4% mortality noted in the present study.

Surgical management of an abdominal impalement injury: a case report / Manejo quirúrgico de una lesion por empalamiento abdominal: reporte de caso

Impalement injuries are a complex and rare type of penetrating abdominal trauma that happens when an object such as a post or a pole penetrates a person injuring several organs, making it a life-threatening situation in which time and correct management play an important part in the survival of the patient. A 37-year-old man suffered abdominal impalement injury with a metal signal post, penetrating the left flank of the abdomen. On examination, there is a hypoventilated left hemithorax with intercostal retractions, increased heart rate, weak distal pulses, delayed capillary refill, and pale skin. A 1-meter-long metal post (approximately 7cm diameter) penetrates the left flank with the entry in the posterior lumbar region. Abdominal viscera, omentum, intestinal content, and ischemic loops of the small intestine are visible. An exploratory laparotomy was performed; left hemicolectomy, end colostomy and Hartmann procedure, resection of the affected jejunum, and end-to-end anastomosis were performed. On the ninth postoperative day, an abdominal tomography was performed due to the presence of fever peaks, which reported thrombosis of the left renal artery and emphysematous pyelonephritis, with the presence of a left pararenal collection. A simple left nephrectomy was performed. Postoperative surveillance was satisfactory during the following 5 days. The patient was discharged. An impaled injury is a complex lesion that needs special attention from the medical field for correct management. Although there is some literature about it, we encourage more research to be done about impalement injuries.

Las lesiones por empalamiento son un tipo de traumatismo abdominal penetrante complejo y raro de que se produce cuando un objeto, como un poste o una vara, penetra a una persona lesionando varios órganos, lo que la convierte en una situación potencialmente mortal en la que el tiempo y el manejo correcto juegan un papel importante en la supervivencia del paciente. Un hombre de 37 años sufrió una herida por empalamiento abdominal con un poste de señales de metal, penetrando el flanco izquierdo del abdomen. A la exploración física, hay un hemitórax izquierdo hipoventilado con retracciones intercostales, aumento de la frecuencia cardíaca, pulsos distales débiles, relleno capilar retrasado y piel pálida. Un poste metálico de 1 metro de largo (aproximadamente 7 cm de diámetro) penetra el flanco izquierdo con entrada en la región lumbar posterior. Son visibles las vísceras abdominales, el epiplón, el contenido intestinal y las asas isquémicas del intestino delgado. Se realizó una laparotomía exploradora; Se realizó hemicolectomía izquierda, colostomía terminal y procedimiento de Hartmann, resección del yeyuno afectado y anastomosis terminoterminal. Al noveno día postoperatorio se realiza tomografía abdominal por presencia de picos febriles, que reporta trombosis de arteria renal izquierda y pielonefritis enfisematosa, con presencia de colección pararrenal izquierda. Se realizó nefrectomía izquierda simple. La vigilancia postoperatoria fue satisfactoria durante los siguientes 5 días. El paciente fue dado de alta. Una lesión por empalamiento es una lesión compleja que necesita una atención especial desde el ámbito médico para su correcto manejo. Aunque existe cierta literatura al respecto, alentamos a que se realicen más investigaciones sobre estas lesiones.

Trauma abdominal penetrante por heridas de arma blanca. Manejo laparoscópico vs convencional. Estudio prospectivo y comparativo / Penetrating abdominal trauma due to stab wounds. Laparoscopic vs conventional management. Prospective and comparative study

La evaluación y el manejo del trauma abdominal ha presentado cambios significativos en los últimos tiempos. La laparoscopia en el trauma abdominal penetrante ha sido de gran utilidad principalmente como método diagnóstico, sin embargo, se debería considerar como herramienta terapéutica.Objetivo: Determinar la eficacia del manejo laparoscópico vs el convencional en el tratamiento de pacientes con trauma abdominal penetrante por heridas de arma blanca.Métodos : Estudio experimental, prospectivo, comparativo. La población de estudio estuvo representada por pacientes con diagnóstico de traumatismo abdominal penetrante por herida de arma blanca que ingresaron a la emergencia de cirugía del Hospital Dr. Miguel Pérez Carreño durante el periodo enero 2019 a julio 2021.Resultados : Fueron incluidos 48 pacientes, 28 pacientes del grupo control y 20 pacientes del grupo experimental. Ambos grupos fueron comparables con respecto a edad y sexo. El índice de severidad del trauma (PATI) fue similar en ambos grupos. Las complicaciones y el tiempo quirúrgico no tuvieron diferencias estadísticamente significativas. Las cirugías negativas representaron el 15 % en el grupo laparoscópico vs 11 % en el abordaje convencional. El porcentaje de conversión fue de 15 %. La estancia hospitalaria fue menor en el grupo laparoscópico 3,25 vs 4,6 días (p = 0,04).Conclusión: La cirugía laparoscópica puede considerarse el abordaje de elección en pacientes hemodinámicamente estables con trauma abdominal penetrante por herida de arma blanca, siendo un método seguro y eficaz, brindando los beneficios propios de la cirugía mínimamente invasiva, con baja tasa de complicaciones y una recuperación más rápida(AU)

The evaluation and management of abdominal trauma have changed significantly in recent times. Laparoscopic approach in penetrating abdominal trauma has been useful as diagnostic method, however, its therapeutic value should be considered. Objective: To determine the efficacy of laparoscopy versus laparotomy approach as treatment in patients with penetrating abdominal trauma caused by stab wounds. Methods: We conducted an experimental, prospective and comparative study. Study population was represented by patients with diagnosis of penetrating abdominal trauma due to stab wounds who were admitted to the emergency room of Dr. Miguel Pérez Carreño Hospital between January 2019 and July 2021.Results : 48 patients were included, 28 in the control group and 20 patients in the experimental group. No differences were found between groups regarding age and sex. The penetrating abdominal trauma index (PATI) was similar in both groups. Differences in complications and surgical time were not statistically significant. Non-therapeutic surgeries represented 15 % in laparoscopic group and 11 % in laparotomy group. The conversion percentage was 15 %. Hospital stay were shorter in laparoscopic group, 3.25 vs 4.6 days (p = 0.04). Conclusion: Laparoscopic surgery can be considered the approach of choice in hemodynamically stable patients with penetrating abdominal trauma due to stab wounds. It is a safe and effective method, providing the benefits of minimally invasive surgery, with a low rate of complications and faster patient recovery(AU)

Changing Trends in the Management of Penetrating Abdominal Trauma - from Mandatory Laparotomy towards Conservative Management.

Background: Penetrating abdominal trauma is a commonly encountered emergency surgical condition. Though it is less common compared to blunt abdominal trauma, it is more dramatic due to the nature of the causative modes of injury involved. Mandatory laparotomy, which was earlier advocated for these cases, has gradually been replaced by conservative management in carefully selected cases thereby avoiding the unnecessary complications associated with laparotomy. Aims and objectives: To study the efficacy of conservative management in cases of penetrating abdominal trauma thereby obviating the need for unnecessary laparotomy. Methods: It was a prospective study conducted in a tertiary hospital, involving 64 patients, over a 2 year period. All patients underwent a CT scan to identify their injuries following a clinical examination and patients were managed conservatively or underwent laparotomy based on the CT findings.Results: Of the 64 patients 53 were managed conservatively making it a success rate of 82.81%. Only 2 patients who had a negative CT scan needed a subsequent laparotomy making it a very reliable investigation in these patients. Conclusion: Conservative management for penetrating abdominal trauma patients is effective in the majority of cases and hence can be advocated in the initial management plan of these cases supplemented by serial assessment of physical symptoms and signs, unless laparotomy is considered necessary based on their initial CT or physical examination findings.

Ventajas de la nutrición enteral temprana en pacientes con lesión del intestino delgado en el trauma abdominal penetrante / Benefits of early enteral nutrition in patients with injury of the small bowel in pene-trating abdominal trauma

Objetivo: En el trauma abdominal penetrante se observan frecuentemente lesiones de intestino delgado. Si bien el tratamiento inmediato y quirúrgico de estos pacientes es importante, el manejo postoperatorio, sobre todo la parte nutricional, lo es aún más. Determinar las ventajas que tiene la nutrición enteral temprana en este tipo de pacientes, nos permitirá un mejor manejo de ellos, en la Ciudad Hospitalaria Doctor Enrique Tejera del Estado Carabobo. Métodos: El estudio es una investigación descriptiva, transversal y retrospectiva, revisando 1500 historias clínicas desde enero de 2009 hasta septiembre de 2010, fueron seleccionados 267 pacientes con lesiones de intestino delgado por trauma abdominal penetrante, y solo 44 cumplieron con los criterios de inclusión previamente establecidos. Resultados: Los resultados determinaron que existe predominio del sexo masculino, con un grupo etáreo de mayor incidencia correspondiente a las edades comprendidas entre 21-25 años, con un porcentaje del 38,64 % y el mecanismo de lesión dominante fue el proyectil percutido por arma de fuego con un 38,63 %. El tiempo de hospitalización para los pacientes fue de 11.91 ± 12.38 días y el tiempo promedio de inicio de la dieta es de aproximadamente 3,97 + 2,02 días, observándose que de los pacientes que recibieron soporte nutricional con glutamina sólo el 28,58% presentaron pérdida de peso, 14,29% se desnutrió y 28,58% presentó complicaciones. Conclusión: En los pacientes en los que se inició la dieta de forma temprana, se disminuyó significativamente el tiempo de hospitalización, así como, la aparición de desnutrición y complicaciones(AU)

Objective: In penetrating abdominal trauma are frequently observed small bowel injuries. Although immediate surgical treatment of these patients is important, postoperative management, especially the nutrition, it is even more. Determine the advantages of early enteral nutrition in these patients, will allow better management of them, at Ciudad Hospitalaria Dr. Enrique Tejera, Valencia, Estado Carabobo. Methods: The study is a descriptive, cross-sectional and retrospective, reviewing 1500 medical records from January 2009 to September 2010, were selected 267 patients with small bowel injury penetrating abdominal trauma, and only 44 met the criteria previously established inclusion. Results: The results determined that there is predominance of male age group with a higher incidence for those aged between 21-25 years, with a rate of 38.64% and the dominant mechanism of injury was hammered by the projectile gun with 38.63%. The hospitalization time for patients was 11.91 ± 12.38 days and the median time to onset of the diet is about 3.97 + 2.02 days, showing that patients who received nutritional support with glutamine only 28.58 % had weight loss is 14.29% and 28.58% had malnutrition complications. Conclusion: Those patients who started early diet significantly decreased length of hospitalization and the occurrence of malnutrition and complications(AU)

Laparotomía no-terapéutica en trauma penetrante abdominal y su relación con el estado de intoxicación por alcohol y drogas / Non-therapeutic laparotomy in penetrating abdominal trauma and its relation with the state of alcohol and drugs intoxication

Objetivo: Describir las características de la población sometida a laparotomía exploradora (LAPE) por trauma penetrante abdominal, cuyo resultado fue no terapéutico y observar si el estado de intoxicación por alcohol y/o drogas influye en la realización del procedimiento. Sede: Hospital General de Ciudad Juárez (segundo nivel de atención). Diseño: Estudio prospectivo y de cohorte. Análisis estadístico: Promedios como medida de resumen, prueba exacta de Fisher y prueba de chi cuadrada. Pacientes y métodos: Se estudiaron pacientes con diagnóstico de trauma penetrante abdominal, sometidos a laparotomía exploradora por sospecha de lesión a órgano intraabdominal o retroperitoneal. Las variables fueron: edad, género, estado de intoxicación, tipo de sustancia consumida, mecanismo de lesión, indicación de cirugía, hallazgos quirúrgicos, complicaciones postquirúrgicas y mortalidad. Resultados: Se estudiaron 480 pacientes, 79% fueron sometidos a laparotomía terapéutica y 21% a laparotomía no terapéutica. La incidencia de laparotomía no terapéutica fue de 35% en los heridos por arma blanca y de 13% para los heridos por arma de fuego (p < 0.0001). El estado de intoxicación por alcohol y/o drogas estuvo presente en 87% de los pacientes con laparotomía terapéutica, mientras que en el grupo de pacientes con laparotomía no-terapéutica en el 85%, sin diferencia significativa. En los pacientes sometidos a laparotomía no-terapéutica se encontraron 28 lesiones a órgano intraabdominal. El hemoperitoneo promedio fue de 200 ml (± 100). El tiempo quirúrgico promedio de 94 minutos (± 25). Ocurrieron 17 infecciones de sitio quirúrgico, mortalidad nula y estancia hospitalaria promedio de 4 días (± 2). Conclusión: La laparotomía no-terapéutica no está relacionada a una evaluación prequirúrgica en un paciente con intoxicación alcohólica y/o por drogas.

Objective: To describe the characteristics of a population that was subjected to exploratory laparotomy due to penetrating abdominal trauma, with non-therapeutic results and to observe if the degree of alcohol and/or drug intoxications had an influence on performing the procedure. Setting: General Hospital of Ciudad Juárez (second level health care). Design: Prospective and cohort study. Statistical analysis: Averages as summary measure, Fisher's exact test and chi square test. Patients and methods: We studied patients with abdominal penetrating trauma subjected to exploratory laparotomy due to suspicion of intraabdominal organ injury or retroperitoneal injury. Studied variables were: age, gender, degree of intoxication, type of toxic substance ingested, injury mechanisms, indication for surgery, surgical findings, post-surgical complications, and mortality. Results: We studied 480 patients, 79% were subjected to therapeutic laparotomy and 21% to non-therapeutic laparotomy. Incidence of non-therapeutic laparotomy was of 35% in those injured by stabbing, whereas it was of 13% for those injured by fire arms (p < 0.0001). Intoxication due to alcohol and drugs was encountered in 87% of patients with therapeutic laparotomy, whereas in the group of non-therapeutic laparotomy they accounted for 85%, without significant differences. In patients subjected to non-therapeutic laparotomy, 28 injuries to intraabdominal organs were found. The average hemoperitoneum was of 200 ml (± 100). Average surgical time was of 94 min (± 25). Seventeen infections of the surgical site occurred, mortality was nill, and the average in-hospital stay was of 4 days (± 2). Conclusion: Non-therapeutic laparotomy is not related to a presurgical evaluation in a patient with alcohol and/or drugs intoxication.

Microlaparoscopia en trauma penetrante de abdomen procedimiento en la sala de emergencia con anestesia local / Minilaparoscopy in penetrating abdominal trauma emergency room procedure with local anesthesia

ANTECEDENTES: En el trauma penetrante de abdomen, existe un número de laparotomías innecesarias, con un porcentaje de complicaciones no despreciable. Cuando se identifica lesión del peritoneo, debe ser evaluada la exploración quirúrgica del abdomen. OBJETIVO: Evaluar la penetración del peritoneo, utilizando un método de diagnostico de visión directa. LUGAR DE APLICACIÓN: Hospital de Urgencias de Córdoba. Hospital de trauma. DISEÑO: Se realizó laparoscopia con anestesia local en pacientes con heridas penetrantes de abdomen, que no presentaran evidencias de injuria de órganos intraabdominales en los estudios de imágenes y los cuales se planteaban dudas en el examen físico, para evidenciar lesión del peritoneo. Estudio retrospectivo. POBLACION: Pacientes con trauma penetrante de abdomen, tratados entre mayo de 2004 y enero de 2005, con diagnostico dudoso de violación peritoneal. METODO: Con sedación y anestesia local a nivel umbilical,se coloco un laparoscopio de visión directa, de 5mm y 90°, con el cual se pudo observar todo el peritoneo anterior, los flancos y el diafragma, buscando la herida peritoneal o líquido libre. RESULTADOS: En cuatro pacientes pudo evitarse la laparotomía. Los cuatro restantes se convirtieron a cirugía abierta o videolaparoscopía, de los cuales dos presentaban lesión de víscera hueca, uno hemoperitoneo y otro lesión hepática mínima. No hubo complicaciones en ambos grupos. La estadía del primer grupo fue 13 horas de promedio. CONCLUSIONES: En pacientes seleccionados, la minilaparoscopía resultó útil en disminuir el porcentaje de laparotomías innecesarias y anestesia general y sus complicaciones.

BACKGROUND: There are a number of unnecessary laparotomies in penetrating trauma, with a non worthless percentage of complications. When the peritoneal injury is identified, surgical exploration of the abdomen should be evaluated. OBJECTIVE: Evaluate the penetration of the peritoneum, using a diagnose method with direct vision. SETTING: Hospital de Urgencias de Córdoba. Trauma Hospital. DESIGN: To evidence peritoneum trespassing, laparoscopy was performed with local anaesthesia in patients with penetrating abdominal trauma without signs of abdominal injury in the imaging methods and doubts in the physical examination, in a prospective setting. POPULATION: Patient with penetrating abdominal trauma, treated between May 2004 to January 2005, with doubtful diagnose of peritoneal violation. METHOD: Under sedation and local anaesthesia, a 5 millimetres laparoscope with 90 degrees vision was placed at umbilicus. The anterior abdominal wall, flanks and diaphragm were exanimate, looking for the peritoneal wound or free fluid. RESULTS: Laparotomy could be avoided in four patients. In the four remaining, laparoscopy or conventional surgery was performed. Two presented hollow viscera injury, one hemoperitoneo and the other, minimum liver damage. There were not complications in both groups. The average hospital stay of the first group was 13 hours. CONCLUSIONS: In selected patients, the minilaparoscopy is useful in decreased the percentage of unnecessary laparotomies and general anaesthesia, and its complications.

Trauma abdominal penetrante / Penetrating abdominal trauma

Introducción: el abdomen ocupa el tercer lugar corporal dañado por trauma. La evaluación y la estabilización de los individuos con lesiones en esa región son la piedra angular en los momentos de urgencias. El abordaje diagnóstico y el resultado del tratamiento están influidos por múltiples factores. El mecanismo y los patrones de las lesiones varían. La exploración física es el indicador más confiable para determinar la necesidad de cirugía. El objetivo de esta investigación fue conocer frecuencia, incidencia, factores demográficos, tasa de laparotomías inmediatas y diferidas, y complicaciones asociadas con el trauma abdominal penetrante; así como definir la utilidad del índice de trauma abdominal penetrante (PATI). Material y métodos: estudio observacional, prospectivo, longitudinal, descriptivo, realizado en el Hospital Central “Ignacio Morones Prieto”, San Luis Potosí, México, del 1 de enero al 31 de diciembre de 2005; incluyó pacientes con trauma abdominal penetrante sometidos a laparotomía exploradora. Fueron estudiadas 21 variables y se llevó a cabo análisis estadístico básico, con t de Student, χ2 y ANOVA. Resultados: se operaron 79 pacientes, 93.67 % del sexo masculino; predominaron los pacientes en la tercera década de la vida; numerosas lesiones fueron producidas durante la noche y por violencia interpersonal; 50.6 % estuvo asociado con el consumo de drogas y 63.3 % se debió a instrumento punzocortante. Con más frecuencia las lesiones se localizaron en cuadrante superior izquierdo, inferior derecho y epigastrio, prevaleciendo las heridas únicas; en las asociadas estuvieron involucrados el tórax y las extremidades; de las laparotomías, 92.4 % se realizó en forma inmediata y en 60.53 %, terapéutica. Existieron complicaciones en 39.24 %; 15.19 % fue reintervenido y la mortalidad representó 3.9 %. Conclusión: debido al elevado índice de laparotomías no terapéuticas y negativas, se requiere abordaje más selectivo que incluya la exploración física...

BACKGROUND: The abdomen ranks in third place of body areas injured by trauma. Evaluation and stabilization of these patients form the cornerstone in emergency medicine. Diagnostic approach and treatment outcome are influenced by several factors. Injury mechanism and pattern vary according to geography and there is an association with drugs and alcohol. Physical examination remains the most reliable indicator for surgery. Associated injuries are present in up to 26% of cases. We undertook this study to determine penetrating abdominal trauma incidence and frequency, demographic factors, rate of immediate and delayed laparotomies, and associated complications as well as to define the usefulness of penetrating abdominal trauma index (PATI). METHODS: An observational, prospective, longitudinal descriptive study was carried out at the Hospital Central [quot ]Ignacio Morones Prieto,[quot ] San Luis Potosi, Mexico from January 1, 2005 to December 31, 2005 on patients who underwent exploratory laparotomy for penetrating abdominal trauma. Twenty one variables were studied. Basic statistical analysis, ANOVA, chi(2) and Student's t-test were used. RESULTS: Of the 79 patients who were included, 93.67% were males. The third decade of life was the most affected, with a night presentation being predominant as a result of personal violence. Drug use was observed in 50.6%; stab wounds in 63.3%. The most frequent locations were the left upper and right lower quadrants and epigastrium; solitary wounds were predominant. Associated injuries were most common in the thorax and limbs. Of the laparotomies performed, 92.4% were urgent and 60.53% were therapeutic; 15.19% required reoperations; complications were observed in 39.24%; and mortality rate was 3.9%. CONCLUSIONS: Due to high non-therapeutic and negative laparotomies rates, a more selective approach is needed, including repetitive physical examination and the appropriate use of auxiliary diagnostic studies.

Trauma penetrante de abdomen por arma cortopunzante, y órganos más frecuentemente lesionados. Emergencia del hospital Luis Vernaza, Guayaquil: Enero–junio 2002 / Penetrating trauma of abdomen by a sharp object, and organs but frequently injured. Emergency of the hospital Luis Vernaza, Guayaquil: January-June 2002

Estudio realizado en el área de emergencia del hospital Luis Vernaza de Guayaquil, durante el período de enero–junio 2002. Se escogieron 50 pacientes que ingresaban por trauma penetrante de abdomen por arma cortopunzante.Tipo de estudio: retrospectivo, longitudinal, descriptivo.Objetivos: General: Conocer los órganos mas lesionados en trauma abdominal penetrante por arma cortopunzante.Específicos: 1.Dar atención oportuna y eficaz.2.Instituir el tratamiento oportuno y correcto.3.Identificar la técnica más empleada en pacientes con trauma penetrante abdominal por arma cortopunzante. Resultados: De los 50 pacientes estudiados, el sexo más común fue el masculino, con 44 casos (88%), y la edad 15–20 años en 16 casos (32%), y el órgano más afectado el intestino delgado (yeyuno e íleon) 13 casos (26%). Aunque existió el mismo número de pacientes tratados quirúrgicamente con reporte de órganos indemnes (26%).Conclusiones: Se logró comprobar que el órgano mas afectado resultó el intestino delgado (yeyuno e íleon), cuyo tratamiento fue el de la sutura transversal para las pequeñas perforaciones, y resecciones parciales para perforaciones mayores.

A study carried at the emergency room of the Luis Vernaza hospital of Guayaquil, during the period of January - June of the 2002. 50 patients were chosen that entered for penetrating trauma of abdomen with a sharp object. Study type: Retrospective, descriptive, longitudinal. Objectives: General: to know the organs frequently injured in an abdominal trauma due to injury by sharp object.Specific: 1.To give opportune and effective attention. 2.To institute the opportune and correct treatment 3.To identify the technique employed in patients with abdominal trauma. Results: Of the 50 studied patients, common male sex with 44 cases (88%), and the in ages between 15-20 years in 16 cases (32%), and the organ most affected was the small intestine 13 cases (26%). Conclusions: The organ most affected is the small intestine whose treatment was that of the traverse suture for the small perforations, and partial resections for the big perforations.

Antibioticoterapia no trauma abdominal penetrante com lesão gastrintestinal: estudo comparativo entre dois esquemas terapêuticos / Antibiotic therapy in penetrating abdominal trauma with gastrointestinal lesion: randomized clinical trial with two therapeutics schemes

OBJETIVO: Comparar a eficácia de dois esquemas terapêuticos de antibióticos em vítimas de trauma penetrante de abdome com lesão gastrintestinal. MÉTODO: O estudo selecionou de forma prospectiva e randomizada, vítimas de trauma abdominal penetrante com lesão gastrintestinal, dividindo-os em dois grupos, conforme o esquema terapêutico: cefoxitina perioperatória exclusivamente (Grupo 1) e associação de gentamicina e metronidazol por cinco dias (Grupo 2). Os grupos foram estratificados em três níveis de acordo com o Abdominal Trauma Index (ATI) e os desfechos analisados foram complicações infecciosas em nível de sitio cirúrgico e não cirúrgico. Escores de trauma e diversas variáveis foram coletadas, como mecanismo e intervalo trauma - tratamento, choque à admissão, volume transfundido, tempo cirúrgico e lesões de cólon. RESULTADOS: Ambos os grupos foram semelhantes e perfeitamente comparáveis, demonstrando não haver diferença na eficácia entre os esquemas antibióticos. CONCLUSÃO: Para vítimas de trauma abdominal penetrante com lesão gastrintestinal, o uso de cefoxitina restrito ao perioperatório é perfeitamente válido.

BACKGROUND: To compare the effectiveness of two antibiotics schemes in victims of penetrating abdominal trauma with gastrointenstinal lesions. METHOD: In this prospective and randomized trial, victims of penetrating abdominal trauma with gastrointestinal lesions were distributed into two groups: peroperative cefoxitin only (Group 1) and five days treatment with gentamicin associated to metronidazol (Group 2). The groups were stratified in three levels, in agreement with the Abdominal Trauma Index (ATI). End points were infectious complications at surgical and non surgical sites. Additional trauma scores and data regarding the mechanism of trauma, treatment interval, incidence of shock at the admission, transfused blood volume, surgical time and trans-operative data were collected. RESULTS: Both groups were similar and perfectly comparable, demonstrating that there was no difference in the effectiveness between the antibiotic schemes. CONCLUSIONS: For victims of penetrating abdominal trauma with gastrointestinal lesions, the use of the restricted peroperative cefoxitin scheme is valid.

Trauma abdominal penetrante consecutivo à corrente elétrica industrial / Penetrating abdominal trauma following industrial eletric current

The authors present a case report of a victim of high power electric shock. The main electric lesion was a penetrating abdominal wound with loss of substance of the abdominal wall and an electric lesion of the hepatic segment and of the gallbladder. The surgical treatment included hepatic segmentectomy, cholecystectomy, repair of the abdominal wall with Marlex prosthesis and skin graft, besides the debridment of the lesions of extremities. The postoperative evolution was satisfactory and the follow-up for 6 months didn't show any sequelae.