Professional Documents
Culture Documents
Bowel Injury
Bowel Injury
F. Al-Mashat
Dep of Surgery
Kauh
TYPES :
1. Blunt
2. Penetrating: Stab, Gunshot
3. Operative
Mechanism:
1. Crushing: Compression
2. Shearing: Sudden Deceleration
3. Bursting: Abdominal Pressure
Causes:
1.
2.
3.
4.
Unrecognized : frequent
cause of preventable death
Unreliable
Often1.Masked:
Head Injury
2. Major Fractures
3. Alcohol
Signs:
1.
2.
3.
4.
5.
6.
7.
Investigations:
1.
CBC
2.
U&Es
3.
LFTs
4.
Amylase
5.
Clotting Profile
6.
ABG
7.
Urinalysis
8.
CXR : A-P
9.
KUB
11. Contrast
12. CT
13. U/S
14. IVU /Contrast CT
15. Double Contrast CT
16. Aortography : Embolization
Penetrating:
1. History
2. Examination
Not Sufficient
Blunt :
High Index of Suspicion
Physical signs: Non Specific
1. associated injury
2. Alcohol
3. Neutral PH & bacteria minimal
inflammation
Delay
Laparotomy:
1. Four: Quadrant Survey
2. Control Enteric Contamination
3. Exploration ??
Mesentry
Haematoma & Lacerations: >2cm, expanding, uncontained, near
root mesentomy
Lesser Sac
Proximal Control
Root Mesentry
Mattox
Evacuation
Bowel Resection
+
Enteroenterostomy
Colon Injuries
Majority: Penetrating
Mortality: < 5%
Risk Factors :
Shock: Sustained hypotension
mortality significantly
Duration from injury to surgery
morbidity not up to 12 H
Faecal Contamination
Quantity ?
Major: > one Quadrant
Class II & III: Major -- Sepsis
Associated injuries:
Class I, II, & III: > 2 organs -- Sepsis
PATI > 25, FSS > 25 , Flint >11
Class I: Greater # of associated organ
injury
Anatomic Location:
Class I , II , & III: NO Significant
difference in complications
between right & Left for 1 repair
Blood Transfusion:
4 units critical
> 4 morbidity
Methods of Repair:
Primary Repair: The Standard
Safe Right & Left (I, II, III)
Prospective
Colostomy : Safe, conservative, acceptable
Closure: 10% Morbidity
W. Infection
I. Obstruction
Fistula
Incisional Hernia
Exteriorization:
a. Healing: 5 10 days
b. Colostomy
Abandoned: Failure &
Complications
1. Drains : NO
W. Infection
Sepsis
2. Peritoneal Irrigation
3. Wound:
Definition
a: Open: Significant
Contamination
b: Delayed primary closure: 7 days
Prophylactic Antibiotics
1. Class I & II: Single Pre - OP
aerobic & Anaerobic
2.Class I & II: 24 H hollow
viscus
3. Shock : dose 2 3 folds
Recommendations:
1. Class I & II:
Non Destructive: 1 repair
(Peritonitis )
2. Destructive: 1 repair if:
1 Haemodynamic stable
2 Shock
3 Significant underlying disease
4 Minimal associated injuries
5 - Peritonitis
1. Blood Volume
Pregnancy
venous Pressure
6. GIT motility
Diagnostic Procedures:
Same
1. Limit Radiation/ Shielding
2. Avoid Anaesthesia
3. DPL: Open
4. IVU: Single exposure
5. DIC
6. Early Mobilization of fracture
Special
1. Fetal Heart: Doppler (12w)
2. U/S
3. Placental Separation: Fetal
cells in maternal blood
Treatment: Vigilant
Mother must be saved first
Options: as non pregnant
1. Uterine Injuries
2. Termination
Maternal death
Immediate Delivery
Poor infant survival if maternal
death >15 minutes
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