Ischemic intestinal complications in patients with burns.
Enteral bacterial translocation has been implicated as a major cause of morbidity in instances of trauma, but little clinical evidence of the loss of intestinal mucosal integrity has been documented. A retrospective review of the medical and autopsy records of all patients admitted between 1982 and 1988 was performed to describe the incidence of intestinal pathologic findings. Of all deaths, a total of 53 per cent of adults (greater than 18 years old) and 61 per cent of children (zero to 17 years old) were noted to have ischemic intestinal pathologic findings on autopsy, ranging from superficial necrosis to full thickness mucosal necrosis extending into the omentum. More than 80 per cent of these patients were septic at the time of death, with endogenous intestinal flora species most frequently identified as the causative agent. Less than 1 per cent (n = 16) of the patients admitted were clinically identified with intestinal pathologic examination, surgically explored and underwent resection of the intestine. Despite intervention, this group suffered a 69 per cent mortality rate. Although the documentation of bacterial translocation in a human model may be obscured by other potential sources of contamination, for example, burn wound, in combination with the immunosuppression inherent to the thermally injured, may lead to bacterial contamination of the systemic circulation and, therefore, may be a significant contributor to morbidity and mortality after thermal injury.
Desai
M H
MH
Shriners Burns Institute, Galveston, Texas 77550.
Herndon
D N
DN
Rutan
R L
RL
Abston
S
S
Linares
H A
HA
D000293:Adolescent; D000328:Adult; D000368:Aged; D001424:Bacterial Infections / Q000209:etiology* / Q000401:mortality; D002056:Burns / Q000150:complications* / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007422:Intestines / Q000098:blood supply* / Q000382:microbiology / Q000473:pathology* / Q000601:surgery; D007511:Ischemia / Q000209:etiology / Q000473:pathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009336:Necrosis; D010437:Peptic Ulcer / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies