ABSTRACT
In a review of 72 cases of trauma to the colon we have demonstrated that a 51 per cent primary closure rate can be obtained if the following considerations are used: 1) anatomic location of colon injury, 2) degree of fecal contamination, 3) number of associated organs injured. Considering these factors individually or in combination we were able to perform primary closure in 51 per cent of our patients, without colostomy and without increasing morbidity and mortality. As a result, the number of hospital days and surgical procedures have been reduced.
Subject(s)
Colon/injuries , Wounds, Penetrating/surgery , Adolescent , Adult , Aged , Child , Child, Preschool , Colon/surgery , Colostomy , Female , Humans , Male , Methods , Middle Aged , Postoperative ComplicationsABSTRACT
In summmary, at University Hospital of Jacksonville, we have performed 36 side-to-side choledochoduodenostomies over the past five years. We have repeatedly demonstrated that choledochoduodenostomy is the procedure of choice for obstructing or partially obstructing lesions of the distal or mid common bile duct, and our extensions of the original indications have not affected the morbidity or mortality as previously reported.
Subject(s)
Common Bile Duct/surgery , Duodenum/surgery , Adolescent , Adult , Aged , Child , Female , Gallstones/surgery , Humans , Male , Methods , Middle Aged , Pancreatic Neoplasms/surgery , Pancreatitis/surgeryABSTRACT
During the ten-year period from 1967 to 1977, 50 cases of pancreatic trauma were reviewed. There were 40 gunshot wounds, six stab wounds, and four cases of blunt abdominal trauma. Ten of the patients died, a mortality of 20%. The overall complication rate was 57%, but only 27% had complications attributable to the pancreatic injury. As has been reported by most authors, there is a high incidence of associated injuries. In our series only one patient had isolated pancreatic injury, while 30% had a major vascular injury, and the mortality for this group was 50%. Several methods of treatment were used, but the majority (36 patients) had drainage alone. The others had either resection (five) or Roux-en-Y pancreaticojejunostomy (five). Of particular interest were results of treatment of severe injuries to the head of the pancreas. Early in the series two patients were treated by pancreaticoduodenectomy and both died within 24 hours. During the last year we have treated five similar injuries using a Puestow type of Roux-en-Y pancreaticojejunostomy, with one death and no pancreatic complications. At present we advocate sump tube drainage for most injuries but rely on a Roux-en-Y pancreaticojejunostomy for severe injury to the head of the pancreas rather than resection.
