Management of the injured bowel: preserving bowel continuity as a gold standard

• Published in: BMC surgery Vol. 21; no. 1; pp. 339 - 7
• Main Authors: Tantardini, Camille, Godiris-Petit, Gaëlle, Noullet, Séverine, Raux, Mathieu, Menegaux, Fabrice, Chereau, Nathalie
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 08.09.2021; BioMed Central; BMC
• Subjects: Abdomen; Abdominal Injuries; Abdominal trauma; Abscesses; Analysis; Anastomosis; Anastomosis, Surgical; Blood; Colon; Colon - surgery; Colon injury; Complications; Continuity; Emergency medical services; Endocrinology and metabolism; Fistula; Human health and pathology; Humans; Injuries; Intestines - surgery; Ischemia; Laparotomy; Life Sciences; Mesentery; Morbidity; Mortality; Ostomy; Patients; Postoperative Complications - epidemiology; Retrospective Studies; Risk analysis; Risk factors; Sepsis; Small bowel injury; Small intestine; Stoma; Strategy; Surgery; Sutures; Trauma; Treatment Outcome; Wound healing; Wounds and injuries; Abdominal trauma; Fistula; Stoma; Colon injury; Small bowel injury
• ISSN: 1471-2482; 1471-2482
• DOI: 10.1186/s12893-021-01332-x

Management of bowel traumatic injuries is a challenge. Although anastomotic or suture leak remains a feared complication, preserving bowel continuity is increasingly the preferred strategy. The aim of this study was to evaluate the outcomes of such a strategy. All included patients underwent surgery for bowel traumatic injuries at a high volume trauma center between 2007 and 2017. Postoperative course was analyzed for abdominal complications, morbidity and mortality. Among 133 patients, 78% had small bowel injuries and 47% had colon injuries. 87% of small bowel injuries and 81% of colon injuries were treated with primary repair or anastomosis, with no difference in treatment according to injury site (p = 0.381). Mortality was 8%. Severe overall morbidity was 32%, and abdominal complications occurred in 32% of patients. Risk factors for severe overall morbidity were stoma creation (p = 0.036), heavy vascular expansion (p = 0.005) and a long delay before surgery (p = 0.023). Fistula rate was 2.2%; all leaks occurred after repairing small bowel wounds. Primary repair of bowel injuries should be the preferred option in trauma patient, regardless of the site-small bowel or colon-of the injury. Stoma creation is an important factor for postoperative morbidity, which should be weighed against the risk of an intestinal suture or anastomosis.