ABSTRACT
INTRODUCTION: The management of colon injuries has distinctly evolved over the last three decades. However, trauma surgeons often find themselves in a dilemma, whether to perform a diversion or to perform a primary repair. The purpose of this study is to evaluate risk factors in colon injury management and their influence on abdominal complications. PATIENTS AND METHODS: This is a prospective study conducted at a national level I trauma center in Tirana, Albania from January 2009 to December 2012. The data with respect to demographics, physiological risk factors, intraoperative findings, and surgical procedures were collected. Colonic injury-related morbidity and mortality were analyzed. Multivariate logistic regression analysis was performed by assessing the influence of risk factors on abdominal complications. RESULTS: Of the 157 patients treated with colon injury, was performed a primary repair in 107 (68.15%) of the patients and a diversion in the remaining 50 (31.85%). The mean PATI was 18.6, while 37 (23.6%) of patients had PATI greater than 25. The complications and their frequencies according to the surgical technique used (primay repair vs diversion respectively) includes: wound infections (9.3% vs 50%), anastomotic leak (1.8% vs 8.7%), and intra-abdominal abscess (1.8% vs 6.5%). The multivariate analysis identified two independent risk factors for abdominal complications: transfusions of 4 units of blood within the first 24 hours (OR = 1.2 95% CI (1.03 - 1.57) p =0.02), and diversion (OR = 9.6, 95% CI 4.4 - 21.3, p<0.001). CONCLUSION: Blood transfusions of more than 4 units within the first 24 hours and diversion during the management of destructive colon injuries are both independent risk factors for abdominal complications. The socioeconomic impact and the need for a subsequent operation in colostomy patients are strong reasons to consider primary repair in the management of colon injuries.
Subject(s)
Colectomy , Colon/injuries , Colon/surgery , Ileostomy , Wounds, Penetrating/mortality , Wounds, Penetrating/surgery , Abdominal Abscess/epidemiology , Abdominal Injuries/mortality , Adolescent , Adult , Aged , Aged, 80 and over , Albania/epidemiology , Anastomotic Leak/epidemiology , Blood Transfusion/statistics & numerical data , Child , Colonic Pouches , Female , Humans , Injury Severity Score , Male , Middle Aged , Prospective Studies , Risk Factors , Trauma Centers , Treatment Outcome , Wound Infection/epidemiology , Wounds, Penetrating/diagnosis , Wounds, Penetrating/etiologyABSTRACT
Gunshot injuries of the human body challenge surgical teams in the emergency department. Since such injuries do not follow any rule, every patient should be considered a special case. Our case, of bullet embolism from injured inferior cava vein to the right heart ventricle is a rare one. Such cases make us be more alert for diagnosis and treatment of this kind of injury. Well equipped hospitals and experienced medical teams are necessary for successful outcome.
