Accession Number : ADA620310


Title :   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


Descriptive Note : Journal article


Corporate Author : ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX


Personal Author(s) : Smith, Iain M ; Beech, Zine K ; Lundy, Jonathan B ; Bowley, Douglas M


Full Text : https://apps.dtic.mil/dtic/tr/fulltext/u2/a620310.pdf


Report Date : Apr 2015


Pagination or Media Count : 10


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.


Descriptors :   *ABDOMEN , *MILITARY PERSONNEL , *WOUNDS AND INJURIES , AFGHANISTAN CONFLICT , ANASTOMOSIS , BATTLEFIELDS , BLOOD COAGULATION , COLON , COMBAT SUPPORT , DAMAGE CONTROL , DEMOGRAPHY , DEPLOYMENT , FECES , LOGISTICS PLANNING , MILITARY MEDICINE , MILITARY OPERATIONS , MILITARY SURGEONS , MORTALITY RATE , OPTIMIZATION , ORGANS(ANATOMY) , PATIENTS , RESUSCITATION , STOMACH , SURGERY , SURVIVAL(GENERAL) , THERAPY , TRAUMA


Subject Categories : Anatomy and Physiology
      Medicine and Medical Research
      Weapons Effects(biological)
      Military Operations, Strategy and Tactics


Distribution Statement : APPROVED FOR PUBLIC RELEASE