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The Shock Trauma Manual of Operative Techniques pp 265–282Cite as

Stomach, Small Bowel, and Colon

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Abstract

Gastrointestinal injuries (GI) involving the stomach, small bowel, and colon are common. They occur more often as a result of penetrating than blunt abdominal trauma. Management requires a high index of suspicion as missed injuries lead to increased morbidity and mortality. Physical examination findings along with select radiographic imaging can help guide decision making. Should exploration be required in the hemodynamically unstable patient, early initiation of damage control should be implemented and significant focus placed on prevention of acidosis, coagulopathy, and hypothermia. The surgeon should always attempt to get optimal exposure as this will minimize chances of missed injury. Initial management should focus on hemorrhage control followed by control of contamination. Patient physiology should be the key driver of decision making when deciding on definitive repair. In general, gastric injuries can usually be repaired in either single- or two-layered fashion. Larger areas of injury may require stapled nonanatomic resection. The small bowel and colon can similarly be managed by either primary repair, hand-sewn or stapled anastomoses, or resection, leaving the two ends in discontinuity. A colostomy can be created either at the primary or subsequent second-look laparotomy, depending on patient physiology. Temporary abdominal closure devices allow for continued resuscitation and rewarming of the patient prior to definitive repair.

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Author information

Authors and Affiliations

  1. Trauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    Mayur Narayan M.D., M.P.H., M.B.A., F.A.C.S.

  2. Center for Injury Prevention and Policy, RUniversity of Maryland School of Medicine, Baltimore, MD, USA

    Mayur Narayan M.D., M.P.H., M.B.A., F.A.C.S.

Authors
  1. Mayur Narayan M.D., M.P.H., M.B.A., F.A.C.S.
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Editors and Affiliations

  1. Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA

    Thomas M. Scalea

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Narayan, M. (2015). Stomach, Small Bowel, and Colon. In: Scalea, T. (eds) The Shock Trauma Manual of Operative Techniques. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2371-7_14

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  • DOI: https://doi.org/10.1007/978-1-4939-2371-7_14

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2370-0

  • Online ISBN: 978-1-4939-2371-7

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