Le lesioni del colon da trauma chiuso dell’addome


COD: 543-548 Categorie: ,

Franco Stagnitti, Pierfederico Salvi, Sergio Corelli, Pietro Gammardella, Francesco Priore, Andrea Stagnitti, Marcello De Pascalis, Francesco Schillaci

Ann. Ital. Chir., 2005; 76: 543-548

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Colon lesions resulting from blunt trauma in the abdomen can be defined as infrequent. Actually, they represent 3-5%
of all hollow organ trauma. They present, however, serious social burden because of its prevalence in males with medium
age ranging from 40 to 70 years. Study was conducted from 1971 to present at the University of Rome “La Sapienza”
Institute of Clinical Emergency Surgery. 42 cases were observed in which 72% had motor vehicle accidents (with less
than 1/4 of these resulting from seat belt). Numerous lesions were associated, especially in the abdomen (31), and the
skull (20), both with Medium OIS 4.2. Most part of the cases was within the OIS-Class III category.
The clinical parameters recorded upon admission revealed particular serious situations with average values of: SAP-92
mm Hg, HR-114, RR-28, GCS-12, RTS-10.8. 17% had shock upon arrival with unsuccessful resuscitation. Ultrasound
results at emergency indicated 62% with effusion/major parenchymal lesion, and 22% with severe peritonitis. 41% were
treated with direct suture, 26% with resection-anastomosis, 19% with primary Hartman resection, and 14% with simple
colostomy. 24% had abdominal complications including 14% sepsis, 5% hemorrhage, and 2 cases of post-surgical
caval thrombus. The overall mortality was 26%. In general these lesions were frightening because of their uncertain
manifestations. In most instances clinical signs related to associate lesions are overlooked, and these often present late
symptoms from 24 to 48 hours. Delayed treatment for untimely diagnosis is one of the yet prevailing complications. The
methods of surgical repair depend on the timing, the nature of associated lesions and, above all, eventual peritoneal contamination.
The primary treatment involves surgical option actually recommended according to the EAST guideline with
specific preference of reconstruction using the primary principle, and resorting to earlier interventions only in the presence
of associated critical factors.