Skip to main content

Bowel Trauma

  • Chapter
  • First Online:
Textbook of Emergency General Surgery

Abstract

Hollow viscus injuries represent a significant portion of overall lesions sustained during penetrating trauma. Currently, isolated small or large bowel injuries are commonly managed via primary repair or primary anastomosis in patients undergoing initial definitive management or deferred anastomosis in patients requiring Damage Control Surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, increases morbidity. By applying this strategy, the overall need for an ostomy (primary or deferred) can be reduced to less than 10%.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 149.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 139.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 199.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Cardi M, Ibrahim K, Alizai SW, Mohammad H, Garatti M, Rainone A, et al. Injury patterns and causes of death in 953 patients with penetrating abdominal war wounds in a civilian independent non-governmental organization hospital in Lashkargah, Afghanistan. World J Emerg Surg. 2019;14:51. https://doi.org/10.1186/s13017-019-0272-z.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Parra-Romero G, Contreras-Cantero G, Orozco-Guibaldo D, Domínguez-Estrada A, del Campo J d JMM, Bravo-Cuéllar L. Abdominal trauma: experience of 4961 cases in western Mexico. Cir Cir (English Ed). 2019;87:183–9. https://doi.org/10.24875/CIRU.18000509.

    Article  Google Scholar 

  3. Oosthuizen GV, Kong VY, Estherhuizen T, Bruce JL, Laing GL, Odendaal JJ, et al. The impact of mechanism on the management and outcome of penetrating colonic trauma. Ann R Coll Surg Engl. 2018;100:152–6. https://doi.org/10.1308/rcsann.2017.0147.

    Article  CAS  PubMed  Google Scholar 

  4. Iaselli F, Mazzei MA, Firetto C, D’Elia D, Squitieri NC, Biondetti PR, et al. Bowel and mesenteric injuries from blunt abdominal trauma: a review. Radiol Med. 2015;120:21–32. https://doi.org/10.1007/s11547-014-0487-8.

    Article  PubMed  Google Scholar 

  5. Cullinane DC, Jawa RS, Como JJ, Moore AE, Morris DS, Cheriyan J, et al. Management of penetrating intraperitoneal colon injuries: a meta-analysis and practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2019;86:505–15. https://doi.org/10.1097/TA.0000000000002146.

    Article  PubMed  Google Scholar 

  6. Ahern DP, Kelly ME, Courtney D, Rausa E, Winter DC. The management of penetrating rectal and anal trauma: a systematic review. Injury. 2017;48:1133–8. https://doi.org/10.1016/j.injury.2017.03.002.

    Article  PubMed  Google Scholar 

  7. Demetriades D, Murray JA, Chan L, Ordoñez C, Bowley D, Nagy KK, et al. Penetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study. J Trauma Inj Infect Crit Care. 2001;50:765–75. https://doi.org/10.1097/00005373-200105000-00001.

    Article  CAS  Google Scholar 

  8. Ashley SW, Cance WG, Chen J, Jurkovich GJ, Napolitano LM, Riall TS. ACS Surgery (7th edition) Principles and Practice. 2014;2. Published by Decker Inc. ISBN 0-615-85974-7.

    Google Scholar 

  9. Gardner J. Blunt and penetrating trauma to the abdomen. Emerg Surg. 2005;23:223–8. https://doi.org/10.1385/1-59259-886-2:095.

    Article  Google Scholar 

  10. Moore EE, Feliciano D V, Mattox KL. Trauma. 2017.

    Google Scholar 

  11. Dhillon RS, Barrios C, Lau C, Pham J, Bernal N, Kong A, et al. Seatbelt sign as an indication for four-vessel computed tomography angiogram of the neck to diagnose blunt carotid artery and other cervical vascular injuries. Am Surg. 2013;79:1001–4.

    Article  PubMed  Google Scholar 

  12. George MJ, Adams SD, McNutt MK, Love JD, Albarado R, Moore LJ, et al. The effect of damage control laparotomy on major abdominal complications: a matched analysis. Am J Surg. 2018;216:56–9. https://doi.org/10.1016/j.amjsurg.2017.10.044.

    Article  PubMed  Google Scholar 

  13. Moore E, Cogbill T, Malangoni M, Jurkovich G, Champion H, Gennarelli T, et al. Organ injury scaling, II: pancreas, duodenum, small bowel, colon and rectum. J Trauma. 1990;30:1427–9.

    Article  CAS  PubMed  Google Scholar 

  14. Advanced trauma life support (ATLS): 10th Edition. 2018. https://doi.org/10.1111/j.1365-2044.1993.tb07026.x.

  15. Ordoñez CA, Parra MW, Serna JJ, Rodríguez HF, García AF, Salcedo A, et al. Damage control resuscitation: REBOA as the new fourth pillar. Colomb Med. 2020; https://doi.org/10.25100/cm.v51i4.4353.

  16. Shanmuganathan K, Mirvis SE, Chiu WC, Killeen KL, Hogan GJF, Scalea TM. Penetrating torso trauma: triple-contrast helical CT in peritoneal violation and organ injury - a prospective study in 200 patients. Radiology. 2004;231:775–84. https://doi.org/10.1148/radiol.2313030126.

    Article  CAS  PubMed  Google Scholar 

  17. Ordoñez CA, Parra MW, Holguín A, García C, Guzmán-Rodríguez M, Padilla N, et al. Whole-body computed tomography is safe, effective and efficient in the severely injured hemodynamically unstable trauma patient. Colomb Med. 2020;51:e4054362. https://doi.org/10.25100/cm.v51i4.4362.

    Article  Google Scholar 

  18. Kim HC, Shin HC, Park SJ, Il PS, Kim HH, Bae WK, et al. Traumatic bowel perforation: analysis of CT findings according to the perforation site and the elapsed time since accident. Clin Imaging. 2004;28:334–9. https://doi.org/10.1016/S0899-7071(03)00244-4.

    Article  PubMed  Google Scholar 

  19. Baron BJ, Benabbas R, Kohler C, Biggs C, Roudnitsky V, Paladino L, et al. Accuracy of computed tomography in diagnosis of intra-abdominal injuries in stable patients with anterior abdominal stab wounds: a systematic review and meta-analysis. Acad Emerg Med. 2018;25:744–57. https://doi.org/10.1111/acem.13380.

    Article  PubMed  Google Scholar 

  20. LeBedis CA, Anderson SW, Soto JA. CT imaging of blunt traumatic bowel and mesenteric injuries. Radiol Clin N Am. 2012;50:123–36. https://doi.org/10.1016/j.rcl.2011.08.003.

    Article  PubMed  Google Scholar 

  21. Matsevych OY, Koto MZ, Aldous C. Laparoscopic-assisted approach for penetrating abdominal trauma: a solution for multiple bowel injuries. Int J Surg. 2017;44:94–8. https://doi.org/10.1016/j.ijsu.2017.06.040.

    Article  PubMed  Google Scholar 

  22. Koto MZ, Matsevych OY, Aldous C. Laparoscopic-assisted approach for penetrating abdominal trauma: an underutilized technique. J Laparoendosc Adv Surg Tech. 2017;27:1065–8. https://doi.org/10.1089/lap.2016.0368.

    Article  Google Scholar 

  23. Ordoñez C, Pino L, Badiel M, Sanchez A, Loaiza J, Ramirez O, et al. The 1-2-3 approach to abdominal packing. World J Surg. 2012;36:2761–6. https://doi.org/10.1007/s00268-012-1745-3.

    Article  PubMed  Google Scholar 

  24. Du Bose JJ, Scalea TM, Brenner M, Skiada D, Inaba K, Cannon J, et al. The AAST prospective Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) registry: Data on contemporary utilization and outcomes of aortic occlusion and resuscitative balloon occlusion of the aorta (REBOA). J Trauma Acute Care Surg. 2016;81(3):409–19. https://doi.org/10.1097/TA.0000000000001079.

    Article  Google Scholar 

  25. Reva VA, Matsumura Y, Hörer T, Sveklov DA, Denisov AV, Telickiy SY, et al. Resuscitative endovascular balloon occlusion of the aorta: what is the optimum occlusion time in an ovine model of hemorrhagic shock? Eur J Trauma Emerg Surg. 2018;44:511–8. https://doi.org/10.1007/s00068-016-0732-z.

    Article  CAS  PubMed  Google Scholar 

  26. Ordoñez CA, Rodríguez F, Orlas CP, Parra MW, Caicedo Y, Guzmán M, et al. The critical threshold value of systolic blood pressure for aortic occlusion in trauma patients in profound hemorrhagic shock. J Trauma Acute Care Surg. 2020;89:1107–13. https://doi.org/10.1097/TA.0000000000002935.

    Article  CAS  PubMed  Google Scholar 

  27. Ordóñez CA, Parra MW, Caicedo Y, Padilla N, Angamarca E, Serna JJ, et al. Damage control surgical management of combined small and large bowel injuries in penetrating trauma: are ostomies still pertinent? Colomb Med. 2021;52(2):e4114425.

    Article  Google Scholar 

  28. Ditzel RM, Anderson JL, Eisenhart WJ, Rankin CJ, DeFeo DR, Oak S, et al. A review of transfusion- and trauma-induced hypocalcemia: is it time to change the lethal triad to the lethal diamond? J Trauma Acute Care Surg. 2020;88:434–9. https://doi.org/10.1097/TA.0000000000002570.

    Article  PubMed  Google Scholar 

  29. Fakhry SM, Watts DD, Luchette FA. Current diagnostic approaches lack sensitivity in the diagnosis of perforated blunt small bowel injury: analysis from 275,557 trauma admissions from the East multi-institutional HVI trial. J Trauma Inj Infect Crit Care. 2003;54:295–306. https://doi.org/10.1097/01.TA.0000046256.80836.AA.

    Article  Google Scholar 

  30. Ordoñez C, García A, Parra MW, Scavo D, Pino LF, Millán M, et al. Complex penetrating duodenal injuries: less is better. J Trauma Acute Care Surg. 2014;76:1177–83. https://doi.org/10.1097/TA.0000000000000214.

    Article  PubMed  Google Scholar 

  31. Ordoñez CA, Pino LF, Badiel M, Sánchez AI, Loaiza J, Ballestas L, et al. Safety of performing a delayed anastomosis during damage control laparotomy in patients with destructive colon injuries. J Trauma Inj Infect Crit Care. 2011;71:1512–8. https://doi.org/10.1097/TA.0b013e31823d0691.

    Article  Google Scholar 

  32. Velmahos GC, Degiannis E, Doll D. Penetrating Trauma. 2012. https://doi.org/10.1213/ane.0b013e3182572adb.

  33. Skube ME, Mallery Q, Lusczek E, Elterman J, Spott MA, Beilman GJ. Characteristics of combat-associated small bowel injuries. Mil Med. 2018;183:e454–9. https://doi.org/10.1093/milmed/usy009.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Roberts DJ, Stelfox HT, Moore LJ, Cotton BA, Holcomb JB, Harvin JA. Accuracy of published indications for predicting use of damage control during laparotomy for trauma. J Surg Res. 2020;248:45–55. https://doi.org/10.1016/j.jss.2019.11.010.

    Article  PubMed  Google Scholar 

  35. Weinberg JA, Croce MA. Penetrating injuries to the stomach, duodenum, and small bowel. Curr Trauma Rep. 2015;1:107–12. https://doi.org/10.1007/s40719-015-0010-2.

    Article  Google Scholar 

  36. Weale R, Kong V, Buitendag J, Ras A, Blodgett J, Laing G, et al. Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa. Trauma Surg Acute Care Open. 2019;4:1–5. https://doi.org/10.1136/tsaco-2018-000235.

    Article  Google Scholar 

  37. Nelson RL, Singer M. Primary repair for penetrating colon injuries. Cochrane Database Syst Rev. 2009;(3):CD002247. https://doi.org/10.1002/14651858.CD002247.

  38. Urbanavičius L. How to assess intestinal viability during surgery: a review of techniques. World J Gastrointest Surg. 2011;3:59. https://doi.org/10.4240/wjgs.v3.i5.59.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Siddharth BR, Keerthi MSS, Naidu SB, Venkanna M. Penetrating injuries to the abdomen: a single institutional experience with review of literature. Indian J Surg. 2017;79:196–200. https://doi.org/10.1007/s12262-016-1459-0.

    Article  PubMed  Google Scholar 

  40. Cleary RK, Pomerantz RA, Lampman RM. Colon and rectal injuries. Dis Colon Rectum. 2006;49:1203–22. https://doi.org/10.1007/s10350-006-0620-y.

    Article  PubMed  Google Scholar 

  41. Demetriades D, Murray JA, Chan LS, Ordoñez C, Bowley D, Nagy KK, et al. Handsewn versus stapled anastomosis in penetrating colon injuries requiring resection: a multicenter study. J Trauma. 2002;52:117–21. https://doi.org/10.1097/00005373-200201000-00020.

    Article  PubMed  Google Scholar 

  42. Naumann DN, Bhangu A, Kelly M, Bowley DM. Stapled versus handsewn intestinal anastomosis in emergency laparotomy: a systemic review and meta-analysis. Surgery (United States). 2015;157:609–18. https://doi.org/10.1016/j.surg.2014.09.030.

    Article  Google Scholar 

  43. Burlew CC, Moore EE, Cuschieri J, Jurkovich GJ, Codner P, Crowell K, et al. Sew it up! A western trauma association multi-institutional study of enteric injury management in the postinjury open abdomen. J Trauma Inj Infect Crit Care. 2011;70:273–7. https://doi.org/10.1097/TA.0b013e3182050eb7.

    Article  Google Scholar 

  44. Loftus TJ, Efron PA, Bala TM, Rosenthal MD, Croft CA, Walters MS, et al. The impact of standardized protocol implementation for surgical damage control and temporary abdominal closure after emergent laparotomy. J Trauma Acute Care Surg. 2019;86:670–8. https://doi.org/10.1097/TA.0000000000002170.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Ordoñez, C.A., Parra, M.W., Caicedo, Y. (2023). Bowel Trauma. In: Coccolini, F., Catena, F. (eds) Textbook of Emergency General Surgery. Springer, Cham. https://doi.org/10.1007/978-3-031-22599-4_97

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-22599-4_97

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-22598-7

  • Online ISBN: 978-3-031-22599-4

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics