Risk factors and prognosis of lower digestive tract haemorrhage in severe burns: a 12-year retrospective analysis.
OBJECTIVE
To explore the risk factors relating to lower digestive tract haemorrhage in severe burns and summarise the experience in clinical diagnosis and treatment.


METHODS
General data of 103 patients with severe extensive burns (EBs) admitted to our burn centre in Shanghai between 1997 and 2009 were reviewed retrospectively. The risk factors relating to EB-complicated lower digestive tract haemorrhage were analysed systematically with respect to the clinical features and experiences in treatment, and prognosis.


RESULTS
Of the 103 severe EBs, five developed lower digestive tract haemorrhage with an occurrence of 4.9%. Four of them were proved to have multiple mucosal erosions in caecum, colon and rectum, and the remaining one was proved rectal ulcerative haemorrhage. In comparison with upper digestive tract haemorrhage, lower digestive tract haemorrhage in the present group was characterised by a longer duration (median 4.0 days, interquartile range (IQR) 1.5-14.5 days vs. median 2.0 days (IQR 1.0-3.0 days), P < 0.05). Deep burns, especially fourth-degree burns, with complications of severe systemic infection, formed the main risk factors relating to lower digestive tract haemorrhage in severe EB patients.


CONCLUSIONS
Severe EB-complicated lower digestive tract haemorrhage is a critical condition in burns, which usually have deep wounds with severe infection surfaces that are difficult to deal with. Enteroscopic haemostasis in controlling lower digestive tract haemorrhage is usually ineffective. Clinical experiences indicate that early management of the wound with effective preventive and therapeutive measures for infection control may be a good choice in the prevention and treatment of lower digestive tract haemorrhage leading to improvement in its prognosis.
Department of Burn Surgery, Changhai Hospital, The Second Military Medical University, Shanghai 200433, People's Republic of China.
Bing
B
Xie
Shi-chu
SC
Xiao
Shi-hui
SH
Zhu
Guang-yi
GY
Wang
Kai-yang
KY
Lv
Heng-yu
HY
Li
Guang-qing
GQ
Wang
Zhao-fan
ZF
Xia
D000328:Adult; D002056:Burns / Q000150:complications* / Q000628:therapy; D005260:Female; D005440:Fluid Therapy; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D041741:Lower Gastrointestinal Tract; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors