Primary closure in colon trauma.

BACKGROUND: Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. METHODS: This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. RESULTS: There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury. CONCLUSIONS: Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

Cierre primario en trauma de colon / Primary closure in colon trauma

Objetivo: Informar si la evolución > 6 horas, grado de contaminación y lesión, sitio anatómico lesionado, PATI (penetrating abdominal trauma index) > 25 y presencia de otras lesiones en trauma de colon, se asocian a mayor morbimortalidad en pacientes con lesión colónica a quienes se les realizó cierre primario. Material y métodos: Estudio prospectivo, observacional, longitudinal, descriptivo, en el Hospital Central “Dr. Ignacio Morones Prieto”, San Luis Potosí. Se incluyeron pacientes con trauma abdominal sometidos a cirugía que presentaron lesión colónica. Análisis estadístico básico con χ2. Resultados: 481 pacientes fueron intervenidos por trauma abdominal; 77 (16.1 %) tuvieron lesión colónica, de los cuales 90 % (n = 69) se intervino en las primeras seis horas; 91 % fue lesión penetrante. El colon transverso fue el más lesionado (38 %, n = 29); las lesiones grado I y II representaron 75.3 % (n = 58). Se efectuó cierre primario en 76.66 % (n = 46), resección con anastomosis en 8.3 % (n = 5) y colostomía en 15 % (n = 9). Hubo lesiones asociadas en 76.6 % (n = 59) y contaminación en 85.7 % (n = 66); 82.8 % (58) tuvo PATI < 25; complicaciones asociadas al procedimiento operatorio, 28.57 % (n = 22); reintervenciones, 10 % (n = 8); estancia hospitalaria promedio, 11.4 días; mortalidad no relacionada a lesión de colon, 3.8 % (n = 3). Conclusiones: El cierre primario es un procedimiento seguro para el tratamiento de lesiones colónicas. Los pacientes con cierre primario presentaron menor morbilidad (p < 0.009). Los pacientes con cirugía en las primeras seis horas (p < 0.006) y estabilidad hemodinámica (p < 0.014) tuvieron menor riesgo de complicación.

BACKGROUND: Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality. METHODS: This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis. RESULTS: There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury. CONCLUSIONS: Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.

[Are antimicrobials useful in closed thoracostomy due to trauma?]. / Utilidad de los antimicrobianos en la toracostomía cerrada por trauma.

BACKGROUND: Thoracic trauma accounts for 25% of deaths due to trauma. Chest trauma patients generally present to the emergency room with pneumo- or hemothorax. According to the majority of the studies, management of closed thoracostomy for trauma includes the use of antimicrobial drugs to prevent infectious complications, but this has not been proven to be beneficial. We undertook this study to evaluate antimicrobial use in thoracic trauma patients with closed thoracostomy and its impact on the development of infectious complications. METHODS: We carried out a prospective, randomized, double blind, comparative study. Patients with isolated chest trauma requiring closed thoracostomy were divided into two groups. Group A received cefalotin, and group B received placebo. Ages ranged from 15-65 years. Results were analyzed with chi(2) and Fisher exact test. RESULTS: One hundred twenty six patients were included in this study. There were 63 patients in each group with similar demographic characteristics. The mean length of hospital stay with the tube was 6.56 days, but the average stay was 11 days for patients who developed empyema. Eight patients developed empyema, three patients with empyema belonged to group A patients and five patients with empyema belonged to group B. For empyema management, five cases were resolved by chest drainage, two cases required thoracoscopic cleaning and drainage and one patient was resolved with thoracotomy and pleural decortication. Bivariate analysis comparing antimicrobial use vs. empyema and length of drainage vs. antimicrobials did not show a statistically significant difference. CONCLUSIONS: The present study did not demonstrate that antimicrobial use was beneficial in the prevention of pleural infections in the management of chest trauma patients requiring closed thoracostomy.

Utilidad de los antimicrobianos en la toracostomía cerrada por trauma / Are antimicrobials useful in closed thoracostomy due to trauma?

Introducción: Una cuarta parte de las muertes en trauma son por trauma torácico. El paciente con trauma torácico generalmente presenta neumotórax o hemotórax, los cuales predisponen a complicaciones infecciosas que dependen de múltiples factores. El manejo en muchas instituciones incluye antimicrobianos para prevenir complicaciones infecciosas, si bien no está demostrada la reducción de la incidencia de infecciones. El objetivo de nuestra investigación fue evaluar la utilidad de los antimicrobianos en trauma torácico. Material y métodos: Estudio clínico controlado, doble ciego, analítico, longitudinal, prospectivo, comparativo, de dos grupos: A recibió cefalotina y B, placebo. Rango de edad de 15 a 65 años. El análisis estadístico se llevó a cabo con χ2 o prueba exacta de Fisher. Resultados: 126 pacientes fueron incluidos en el estudio, 63 en cada grupo, con similares características demográficas. La media de días con pleurostomía fue de 6.56, pero en quienes desarrollaron empiema fue de 11; la incidencia del empiema fue de 6.4 % (n = 8). Tres pacientes con empiema fueron del grupo A y cinco del B; tres empiemas fueron complejos y cinco simples; dos requirieron toracoscopia y uno toracotomía; cinco curaron con sonda endopleural. Al relacionar en el análisis bivariado el uso de antimicrobiano versus empiema y días de estancia, no se identificó diferencia estadísticamente significativa. Conclusiones: Este estudio no demostró que los antimicrobianos sean útiles para prevenir infecciones pleurales en trauma torácico.

BACKGROUND: Thoracic trauma accounts for 25% of deaths due to trauma. Chest trauma patients generally present to the emergency room with pneumo- or hemothorax. According to the majority of the studies, management of closed thoracostomy for trauma includes the use of antimicrobial drugs to prevent infectious complications, but this has not been proven to be beneficial. We undertook this study to evaluate antimicrobial use in thoracic trauma patients with closed thoracostomy and its impact on the development of infectious complications. METHODS: We carried out a prospective, randomized, double blind, comparative study. Patients with isolated chest trauma requiring closed thoracostomy were divided into two groups. Group A received cefalotin, and group B received placebo. Ages ranged from 15-65 years. Results were analyzed with chi(2) and Fisher exact test. RESULTS: One hundred twenty six patients were included in this study. There were 63 patients in each group with similar demographic characteristics. The mean length of hospital stay with the tube was 6.56 days, but the average stay was 11 days for patients who developed empyema. Eight patients developed empyema, three patients with empyema belonged to group A patients and five patients with empyema belonged to group B. For empyema management, five cases were resolved by chest drainage, two cases required thoracoscopic cleaning and drainage and one patient was resolved with thoracotomy and pleural decortication. Bivariate analysis comparing antimicrobial use vs. empyema and length of drainage vs. antimicrobials did not show a statistically significant difference. CONCLUSIONS: The present study did not demonstrate that antimicrobial use was beneficial in the prevention of pleural infections in the management of chest trauma patients requiring closed thoracostomy.

[Surgical site infection in non-traumatic surgery]. / Infección del sitio operatorio en cirugía abdominal no traumática.

BACKGROUND: Risk factors of surgical site infection (SSI) have been widely studied, such as abdominal surgery, surgical time >2 h, contaminated or dirty surgery, three or more diagnoses at discharge, and ASA classification >II. METHODS: A prospective risk factor study was carried out for SSI in patients who underwent non-traumatic abdominal surgery, comparing an institutional (Secretary of Health) and a private third-level hospital during the period from October 2001 to May 2002. RESULTS: We studied 527 patients with 21 cases (3.98%) of SSI and four deaths due to this cause, 0.75% of the total population and 19% of patients with SSI. The mean age was 47.5 +/- 19.1 years, and there were 195 (37%) males and 332 (63%) females. The incidence of SSI in the private hospital was 2.1% and in the institutional hospital 5%, without statistical significance (p = 0.09). Within the infected group we found 14 superficial infections, 5 deep infections, and 2 infections in the organ or surgical field. Variables included in the models of logistic regression were smoke, blood transfusion, trichotomy, and wound type. CONCLUSIONS: Observed infection incidence was within the expected range. In our study there were no differences between facilities, and SSI incidence is similar to what has previously been reported.

Infección del sitio operatorio en cirugía abdominal no traumática / Surgical site infection in non-traumatic surgery

BACKGROUND: Risk factors of surgical site infection (SSI) have been widely studied, such as abdominal surgery, surgical time >2 h, contaminated or dirty surgery, three or more diagnoses at discharge, and ASA classification >II. METHODS: A prospective risk factor study was carried out for SSI in patients who underwent non-traumatic abdominal surgery, comparing an institutional (Secretary of Health) and a private third-level hospital during the period from October 2001 to May 2002. RESULTS: We studied 527 patients with 21 cases (3.98%) of SSI and four deaths due to this cause, 0.75% of the total population and 19% of patients with SSI. The mean age was 47.5 +/- 19.1 years, and there were 195 (37%) males and 332 (63%) females. The incidence of SSI in the private hospital was 2.1% and in the institutional hospital 5%, without statistical significance (p = 0.09). Within the infected group we found 14 superficial infections, 5 deep infections, and 2 infections in the organ or surgical field. Variables included in the models of logistic regression were smoke, blood transfusion, trichotomy, and wound type. CONCLUSIONS: Observed infection incidence was within the expected range. In our study there were no differences between facilities, and SSI incidence is similar to what has previously been reported.

[Esophageal perforation]. / Perforación esofágica.

OBJECTIVE: We describe our experience in the management of esophageal perforation. MATERIAL AND METHODS: Retrolective study of the esophageal perforation patients, managed from January 1999 to December 2003. Analyzed variables were age, sex, aetiology, time of diagnosis and treatment, as well as ancillary methods employed, mode of treatment and morbidity and mortality. RESULTS: We found 13 patients: eight males (61.54%) and five females (38.46%), with an average age of 36.07 years with standard deviation of 19.77. Penetrating trauma was the leading cause in six cases, continued by iatrogenic perforation in four, Boerhaave's syndrome in one, foreign body in one, and blunt abdominal trauma in one. The principal symptom was pain in 84.61% of the cases. The esophagogram confirmed diagnosis in six cases (46.15%). The diagnosis was accomplished early in eight patients (61.54%) and late in five patients (38.46%). Nonsurgical treatment was carried out in two cases (15.38%) and surgical in 11 patients (84.62%). The average hospital stay was 22.45 days. Mortality in general was 15.38%, 0% for those with an early diagnosis and management and 40% for those delayed. CONCLUSIONS: An early diagnosis of esophageal perforation with the appropriate management (surgical or nonsurgical) will considerably diminish patient morbidity and mortality. A treatment choice could not be defined for the early or late diagnosis, but if surgical treatment is undertaken, adequate drainage for the perforation should be instituted as one of its principles.

[Ascaris lumbricoides-caused risk factors for intestinal occlusion and subocclusion]. / Factores de riesgo para oclusión y suboclusión intestinal por Ascaris lumbricoides.

OBJECTIVES: Our objective was to determine risk factors and mortality for partial and complete bowel obstruction caused by Ascaris lumbricoides as well as diagnostic validity of eosinophilia in peripheral blood. MATERIAL AND METHODS: We studied 50 patients with partial or complete bowel obstruction and expulsion of Ascaris lumbricoides by mouth or anus, as well as 50 patients as controls; no patient had a negative coproparasitoscopic study. The period of study was from January 1995-December 2001 at the General Hospital of Ciudad Valles, San Luis Potosí State, Mexico. RESULTS: Cases with partial bowel obstruction had average age of 3.1 years against 10.13 years for those with complete obstruction (p = 0.029). Females accounted for 55% and males 43%, respectively. We do not find a relationship among nutritional status, gestational order in the family, and place of excreta deposition in this study group. In the case of eosinophilia, best point of section found was three or more eosinophils with sensitivity of 34% but specificity of 100%; mortality was 2%. CONCLUSIONS: We do not find a statistical difference between partial and complete bowel obstruction for different variables studied with the exception of age. To find 3% or more of eosinophils in peripheral blood strongly suggests the etiology of the obstruction as Ascaris lumbricoides at prevalence sites of this parasite.