title: Vasopressor use after initial damage control laparotomy increases risk for anastomotic disruption in the management of destructive colon injuries.
abstract: BACKGROUND
  Management of destructive colon injuries during damage control (DC) laparotomy is debated. The authors reviewed a single institution's experience with destructive colon injuries to identify risk factors for anastomotic failure after colon reconstruction.
  
  
  METHODS
  The authors identified all trauma patients sustaining destructive colon injuries between 2002 and 2011 from their medical center's trauma registry. Anastomotic leak was defined as suture or staple line disruption or enteral fistula formation.
  
  
  RESULTS
  Of 171 identified patients, 68 had DC procedures, 41 (60%) had subsequent anastomoses performed during the same hospitalization, and 27 (40%) were diverted. The colon anastomotic leak rate in patients who underwent DC laparotomy was higher than in patients who were reconstructed at the primary operation in a non-DC setting (17% vs 6%, P = .09). The use of vasopressors after the initial DC operation more than quadrupled the leak rate to 50% (P = .02).
  
  
  CONCLUSIONS
  Colonic anastomotic disruptions yield deadly consequences, and diversion rather than anastomosis should be used in patients who require vasopressor support after the initial DC procedure.
authors.affiliation: Trauma/Surgical Critical Care & Acute Care Surgery, F.H. "Sammy" Ross Trauma Center, Carolinas Medical Center, PO Box 32861, Charlotte, NC 28232-2861, USA. Electronic address: peter.fischer@carolinashealthcare.org.
authors.forename: Peter E
authors.initials: PE
authors.lastname: Fischer
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Nunn
authors.forename: Blair A
authors.initials: BA
authors.lastname: Wormer
authors.forename: A Britton
authors.initials: AB
authors.lastname: Christmas
authors.forename: Lindsay A
authors.initials: LA
authors.lastname: Gibeault
authors.forename: John M
authors.initials: JM
authors.lastname: Green
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Sing
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical / Q000379:methods; D057868:Anastomotic Leak / Q000517:prevention & control*; D003106:Colon / Q000293:injuries* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007813:Laparotomy / Q000379:methods*; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012421:Rupture / Q000601:surgery; D015599:Trauma Severity Indices; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use*; D014950:Wounds, Penetrating / Q000175:diagnosis / Q000188:drug therapy / Q000601:surgery*
chemical_list: D014662:Vasoconstrictor Agents
keywords: Colon anastomosis; Damage control; Vasopressors