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  1. Home /
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  3. Vol 52 No 2 (2021): Damage Control Surgery (II) /
  4. Reviews

Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?

  • Abstract
  • Keywords
  • Author Biographies
  • References

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 anastomosis in patients undergoing definitive laparotomy or deferred anastomosis in patients requiring damage control surgery. The traditional surgical dogma of ostomy has proven to be unnecessary and, in many instances, actually increases morbidity. The aim of this article is to delineate the experience obtained in the management of combined hollow viscus injuries of patients suffering from penetrating trauma. We sought out to determine if primary and/or deferred bowel injury repair via anastomosis is the preferred surgical course in patients suffering from combined small and large bowel penetrating injuries. Our experience shows that more than 90% of all combined penetrating bowel injuries can be managed via primary or deferred anastomosis, even in the most severe cases requiring the application of damage control principles. Applying this strategy, the overall need for an ostomy (primary or deferred) could be reduced to less than 10%.

Authors

  • Carlos Alberto Ordoñez • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. https://orcid.org/0000-0003-4495-7405
  • Michael Parra Department of Trauma Critical Care, Broward General Level I Trauma Center, Fort Lauderdale, FL – USA
  • Yaset Caicedo Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia https://orcid.org/0000-0002-6128-0128
  • Natalia Padilla Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia https://orcid.org/0000-0003-3292-6919
  • Edison Angamarca Department of Surgery. Hospital UTPL, Loja, Ecuador. https://orcid.org/0000-0002-7904-2646
  • Jose Julian Serna  Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia.  Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia.  Universidad Icesi, Cali, Colombia.  Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0001-9829-8930
  • Fernando Rodriguez Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia
  • Alberto Garcia • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. https://orcid.org/0000-0002-4096-1434
  • Alexander Salcedo • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0001-8187-0638
  • Luis Fernando Pino • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0002-1179-2854
  • Adolfo Gonzalez Hadad • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia. https://orcid.org/0000-0001-5862-4906
  • Mario Alain Herrera • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0002-4526-7636
  • Laureano Quintero • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia. https://orcid.org/0000-0001-8730-2447
  • Fabian Hernandez • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. https://orcid.org/0000-0002-2974-0649
  • Maria Josefa Franco Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia https://orcid.org/0000-0003-2063-0336
  • Gonzalo Aristizabal Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia https://orcid.org/0000-0003-4363-7768
  • Luis Eduardo Toro Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia https://orcid.org/0000-0001-5012-8350
  • Monica Guzman • Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile https://orcid.org/0000-0002-5515-263X
  • Federico Coccolini • Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy https://orcid.org/0000-0001-6364-4186
  • Ricardo Ferrada • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia. https://orcid.org/0000-0003-2391-5628
  • Rao Ivatury Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA https://orcid.org/0000-0001-7208-7836

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Keywords

  • Penetrating Combined Small and Large Bowel Injuries
  • Damage Control Surgery
  • Definitive Laparotomy
  • Primary Anastomosis
  • Deferred Anastomosis
  • Ostomy.
  • Injury Severity Score
  • Laparotomy
  • Anastomotic Leak
  • Surgical Anastomosis
  • Fistula

Author Biographies


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0003-4495-7405


, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0002-6128-0128


, Centro de Investigaciones Clínicas (CIC), Fundación Valle del Lili, Cali, Colombia

orcid_id14.png https://orcid.org/0000-0003-3292-6919


, Department of Surgery. Hospital UTPL, Loja, Ecuador.

orcid_id14.png https://orcid.org/0000-0002-7904-2646


,  Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia.  Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia.  Universidad Icesi, Cali, Colombia.  Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-9829-8930


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4096-1434


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Universidad Icesi, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-8187-0638


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-1179-2854


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-5862-4906


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-4526-7636


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0001-8730-2447


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Division of Trauma and Acute Care Surgery, Department of Surgery. Hospital Universitario del Valle, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0002-2974-0649


, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia

orcid_id14.png https://orcid.org/0000-0003-2063-0336


, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia

orcid_id14.png  https://orcid.org/0000-0003-4363-7768


, Division of Trauma and Acute Care Surgery, Department of Surgery. Fundación Valle del Lili. Cali, Colombia

orcid_id14.png https://orcid.org/0000-0001-5012-8350


, • Instituto de Ciencias Biomédicas, Facultad de Medicina, Universidad de Chile, Santiago de Chile, Chile

orcid_id14.png https://orcid.org/0000-0002-5515-263X


, • Department of General, Emergency and Trauma Surgery, Pisa University Hospital, Pisa, Italy

orcid_id14.png https://orcid.org/0000-0001-6364-4186


, • Division of Trauma and Acute Care Surgery, Department of Surgery. Universidad del Valle, Cali, Colombia. • Centro Médico Imbanaco, Cali, Colombia.

orcid_id14.png https://orcid.org/0000-0003-2391-5628


, Professor Emeritus Virginia Commonwealth University, Richmond, VA, USA

orcid_id14.png https://orcid.org/0000-0001-7208-7836

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2021-04-28
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2020-07-01
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How to Cite
Ordoñez, C. A., Parra, M., Caicedo, Y., Padilla, N., Angamarca, E., Serna, J., Rodriguez, F., Garcia, A., Salcedo, A., Pino, L., Gonzalez Hadad, A., Herrera, M., Quintero, L., Hernandez, F., Franco, M., Aristizabal, G., Toro, L., Guzman, M., Coccolini, F., Ferrada, R., & Ivatury, R. (2021). Damage control surgical management of combined small and large bowel injuries in penetrating trauma: Are ostomies still pertinent?. Colombia Médica, 52(2), e4114425. https://doi.org/10.25100/cm.v52i2.4425
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Universidad del Valle
Universidad del Valle
  • Cali - Colombia
  • © 1994 - 2020
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2020 Universidad del Valle - Vigilada MinEducación

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