A Prospective Observational Study of Abdominal Injury Management in Contemporary Military Operations: Damage Control Laparotomy Is Associated With High Survivability and Low Rates of Fecal Diversion

Abstract

This study describes the cause, management, and outcomes of abdominal injury in a mature deployed military trauma system, with particular focus on damage control, hollow visceral injury (HVI), and stoma utilization. Background: Damage control laparotomy (DCL) is established in military and civilian practice. However, optimal management of HVI during military DCL remains controversial. We studied abdominal trauma managed over 5 months at the Joint Force Combat Support Hospital, Camp Bastion, Afghanistan (Role 3). Data included demographics, wounding mechanism, injuries sustained, prehospital times, location of first laparotomy (Role 3 or forward), use of DCL or definitive laparotomy, subsequent surgical details, resource utilization, complications, and mortality. Ninety-four of 636 trauma patients (15%) underwent laparotomy. Military injury mechanisms dominated [44 gunshot wounds (47%), 44 blast (47%), and 6 blunt trauma (6%)]. Seventy-two of 94 patients (77%) underwent DCL. Four patients were palliated. Seventy of 94 (74%) sustained HVI; 44 of 70 (63%) had colonic injury. Repair or resection with anastomosis was performed in 59 of 67 therapeutically managed HVI patients (88%). Six patients were managed with fecal diversion, and 6 patients were evacuated with discontinuous bowel. Anastomotic leaks occurred in 4 of 56 HVI patients (7%) with known outcomes. Median New Injury Severity Score for DCL patients was 29 (interquartile range: 18 41) versus 19.5 (interquartile range: 12 34) for patients undergoing definitive laparotomy ( P = 0.016). Overall mortality was15of94(16%). Damage control is now used routinely for battlefield abdominal trauma. In a well-practiced Combat Support Hospital, this strategy is associated with low mortality and infrequent fecal division.

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Document Details

Document Type
Technical Report
Publication Date
Apr 01, 2015
Accession Number
ADA620310

Entities

People

  • Douglas M. Bowley
  • Iain M. Smith
  • Jonathan B. Lundy
  • Zine K. Beech

Organizations

  • United States Army Institute of Surgical Research

Tags

DTIC Thesaurus Topics

  • Abscesses
  • Blood
  • Combat Injuries
  • Combat Support Hospitals
  • Computer Programs
  • Health Services
  • Hospitals
  • Medical Personnel
  • Military Hospitals
  • Military Medicine
  • Military Operations
  • Patient Care
  • Second World War
  • Wounds And Injuries

Fields of Study

  • Medicine

Readers

  • Trauma Surgery or Emergency Medicine.
  • Trauma or Military Medicine