Management of destructive bowel injury in the open abdomen.
BACKGROUND
Little attention has been focused on destructive injuries of the bowel in patients requiring open abdominal management. We therefore reviewed our institutional experience for destructive bowel injury requiring open abdominal management with the vacuum pack technique (vac).


METHODS
The trauma registry at a Level I trauma center was used to identify patients sustaining destructive bowel injury for an 11-year period beginning in May 1990. Patients were assessed for pertinent clinical and demographic information, and individuals requiring open abdominal management were compared with those who did not.


RESULTS
One hundred four patients required bowel resection and constitute the study population. Twenty-nine patients had vacs placed, with 22 (75.9%) of the total eventually obtaining delayed fascial closure. Nineteen (183%) patients had resection and primary repair (PR) of large and/or small bowel in conjunction with a vac, 10 (9.6%) patients had stoma formation in conjunction with a vac, 62 (59.6%) patients had resection and PR of small and/or large bowel in conjunction with primary fascial closure, and 13 (12.5%) patients had stoma formation and primary fascial closure. There were no differences in abdominal abscess or leak rates between groups. There were four deaths, none of which was secondary to failure of an anastomosis.


CONCLUSIONS
Bowel resection with PR appears to be a safe alternative after destructive bowel injury and results in acceptable morbidity when performed in conjunction with open abdominal management.
Chavarria-Aguilar
Marco
M
Department of Surgery, University of Tennessee College of Medicine, Erlanger Medical Center, Chattanooga, Tennessee 37403, USA.
Cockerham
William T
WT
Barker
Donald E
DE
Ciraulo
David L
DL
Richart
Charles M
CM
Maxwell
Robert A
RA
D000007:Abdominal Injuries / Q000401:mortality / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D004766:Enterostomy / Q000706:statistics & numerical data; D000071938:Fasciotomy; D005260:Female; D015600:Glasgow Coma Scale; D006465:Hemoperitoneum / Q000601:surgery; D017052:Hospital Mortality; D006801:Humans; D015601:Injury Severity Score; D007422:Intestines / Q000293:injuries* / Q000601:surgery; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D014193:Trauma Centers; D014618:Vacuum; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery*