Surgery, gynecology & obstetrics
-
Surg Gynecol Obstet · Sep 1993
ReviewIdentifying the low-risk patient with penetrating colonic injury for selective use of primary repair.
As the mortality rate for penetrating colonic injuries approaches zero, emphasis has shifted toward reducing associated morbidity. This study was done to identify patients at low risk for colon-related extensive morbidity after primary repair of a penetrating colonic injury. The records of 100 consecutive patients admitted to the District of Columbia General Hospital (DCGH) between 1984 to 1990, surviving more than 24 hours after full-thickness penetrating colonic injuries, were retrospectively reviewed. ⋯ This series from DCGH represents the lowest colon-related extensive morbidity and mortality rates reported to date in any substantial series of penetrating abdominal trauma. We attribute the 2 percent extensive morbidity rate to high TS (mean of 15.7), low PATI (mean of 24.2), low FCIS (mean of 1.9) and few associated intra-abdominal injuries (59 percent of patients with less than two). We have identified a group of patients with full-thickness penetrating injuries to the colon, few associated intra-abdominal injuries, high TS, low PATI and low FCIS who can be managed safely and judiciously by primary repair without undue morbidity and mortality.
-
A safe and effective method for placement of all types of long term Silastic right atrial catheters into the central veins by open cutdown is described. The certainty that the catheter can be passed in this way through either the external or internal jugular vein, using only one incision, allows the procedure to proceed smoothly and without interruption. Percutaneous attempts that have a higher complication rate and cephalic vein cut-downs that are unsuccessful because of inadequate vein caliber are thereby avoided.