Synergistic effect of combined hollow viscus injuries on intra-abdominal abscess formation

Elena M. Paulus, Martin Croce, Charles P. Shahan, Ben L. Zarzaur, John P. Sharpe, Amirtha Dileepan, Brandon S. Boyd, Timothy Fabian

Research output: Contribution to journalArticle

Abstract

The strong association between penetrating colon injuries and intra-abdominal abscess (IAA) formation is well established and attributed to high colon bacterial counts. Since trauma patients are rarely fasting at injury, stomach and small bowel colony counts are also elevated. We hypothesized that there is a synergistic effect of increased IAA formation with concomitant stomach and/or colon injuries when compared to small bowel injuries alone. Consecutive patients at a level one trauma center with penetrating small bowel (SB), stomach (S), and/or colon (C) injuries from 1996 to 2012 were reviewed. Logistic regression determined associations with IAA, adjusting for age, gender, Injury Severity Score (ISS), admission Glasgow Coma Score, transfusions, and concurrent pancreas or liver injury. A total of 1518 patients (91% male, ISS = 15.9 ± 8.4) were identified: 496 (33%) SB, 231 (15%) S, 288 (19%) C, 40 (3%) S + SB, 69 (5%) S + C, 338 (22%) C + SB, and 56 (4%) S + C + SB. 148 (10%) patients developed IAA: 4 per cent SB, 9 per cent S, 10 per cent C, 5 per cent S + SB, 22 per cent S + C, 13 per cent C + SB, and 25 per cent S + C + SB. Multiple logistic regression demonstrated that ISS, 24 hour blood transfusions, and concomitant pancreatic or liver injuries were associated with IAA. Compared with reference SB, S or S + SB injuries were no more likely to develop IAA. However, S + C, SB + C, and S + C + SB injuries were significantly more likely to have IAA. In conclusion, combined stomach + colon, small bowel + colon, and stomach, colon, + small bowel injuries have a synergistic effect leading to increased IAA formation after penetrating injuries. Heightened clinical suspicion for IAA formation is necessary in these combined hollow viscus injury patients.

Original languageEnglish (US)
Pages (from-to)674-678
Number of pages5
JournalAmerican Surgeon
Volume81
Issue number7
StatePublished - Jul 1 2015

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Abdominal Abscess
Viscera
Wounds and Injuries
Colon
Stomach
Injury Severity Score
Logistic Models
Bacterial Load
Trauma Centers
Liver
Coma
Blood Transfusion

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Paulus, E. M., Croce, M., Shahan, C. P., Zarzaur, B. L., Sharpe, J. P., Dileepan, A., ... Fabian, T. (2015). Synergistic effect of combined hollow viscus injuries on intra-abdominal abscess formation. American Surgeon, 81(7), 674-678.

Synergistic effect of combined hollow viscus injuries on intra-abdominal abscess formation. / Paulus, Elena M.; Croce, Martin; Shahan, Charles P.; Zarzaur, Ben L.; Sharpe, John P.; Dileepan, Amirtha; Boyd, Brandon S.; Fabian, Timothy.

In: American Surgeon, Vol. 81, No. 7, 01.07.2015, p. 674-678.

Research output: Contribution to journalArticle

Paulus, EM, Croce, M, Shahan, CP, Zarzaur, BL, Sharpe, JP, Dileepan, A, Boyd, BS & Fabian, T 2015, 'Synergistic effect of combined hollow viscus injuries on intra-abdominal abscess formation', American Surgeon, vol. 81, no. 7, pp. 674-678.
Paulus EM, Croce M, Shahan CP, Zarzaur BL, Sharpe JP, Dileepan A et al. Synergistic effect of combined hollow viscus injuries on intra-abdominal abscess formation. American Surgeon. 2015 Jul 1;81(7):674-678.
Paulus, Elena M. ; Croce, Martin ; Shahan, Charles P. ; Zarzaur, Ben L. ; Sharpe, John P. ; Dileepan, Amirtha ; Boyd, Brandon S. ; Fabian, Timothy. / Synergistic effect of combined hollow viscus injuries on intra-abdominal abscess formation. In: American Surgeon. 2015 ; Vol. 81, No. 7. pp. 674-678.
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abstract = "The strong association between penetrating colon injuries and intra-abdominal abscess (IAA) formation is well established and attributed to high colon bacterial counts. Since trauma patients are rarely fasting at injury, stomach and small bowel colony counts are also elevated. We hypothesized that there is a synergistic effect of increased IAA formation with concomitant stomach and/or colon injuries when compared to small bowel injuries alone. Consecutive patients at a level one trauma center with penetrating small bowel (SB), stomach (S), and/or colon (C) injuries from 1996 to 2012 were reviewed. Logistic regression determined associations with IAA, adjusting for age, gender, Injury Severity Score (ISS), admission Glasgow Coma Score, transfusions, and concurrent pancreas or liver injury. A total of 1518 patients (91{\%} male, ISS = 15.9 ± 8.4) were identified: 496 (33{\%}) SB, 231 (15{\%}) S, 288 (19{\%}) C, 40 (3{\%}) S + SB, 69 (5{\%}) S + C, 338 (22{\%}) C + SB, and 56 (4{\%}) S + C + SB. 148 (10{\%}) patients developed IAA: 4 per cent SB, 9 per cent S, 10 per cent C, 5 per cent S + SB, 22 per cent S + C, 13 per cent C + SB, and 25 per cent S + C + SB. Multiple logistic regression demonstrated that ISS, 24 hour blood transfusions, and concomitant pancreatic or liver injuries were associated with IAA. Compared with reference SB, S or S + SB injuries were no more likely to develop IAA. However, S + C, SB + C, and S + C + SB injuries were significantly more likely to have IAA. In conclusion, combined stomach + colon, small bowel + colon, and stomach, colon, + small bowel injuries have a synergistic effect leading to increased IAA formation after penetrating injuries. Heightened clinical suspicion for IAA formation is necessary in these combined hollow viscus injury patients.",
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