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Wed Jan 17 07:29:20 GMT 2007

Roy

We use 3 doses (ie 24 hours) for all bowel injuries.  We could jprobably ust
use a single does but that's our current protocol.  We do not distinguish
between colon & small bowel injuries in terms of different antibiotic
protocols.  In fact, several studies have shown increased rates of abdominal
abscess with stomach injuries over colon injury (but again we're not giving
peri-op antibiotics for that).

Never leave the skin open for this reason.  (Nor does anyone in the UK -as
far as I am aware - not for this, not for appendicitis, not for faecal
peritonitis).  Frankly I think it's 1950s surgical practice (like 2-layer
bowel anastomoses!)

Karim

On 16/01/07, Roy Danks <roydanks at hotmail.com> wrote:
>
> Karim,
>
> Where is the support for 3 doses?  why would you give that versus 1
> dose?  If a dirty colon injury only needs 24 hrs (take your pick of drug
> that covers), why 3 doses in sm. bowel injury.  Is there literature support
> for this?
>
> Do you leave skin open after penetrating colon trauma and do a delayed
> closure?
>
> RD
>
>
>
> > Date: Mon, 15 Jan 2007 10:05:19 +0000> From: karimbrohi at gmail.com> To:
> trauma-list at trauma.org> Subject: Re: small bowel injury> > 1. 3 doses of
> antibiotics, commencing with the first one pre-op. (Remember> this is for
> reducing wound infection, not to reduce the incidence of> intra-abdominal
> abscess).> > 2. Never leave the skin open (no evidence for any GI surgery)
> unless you> need to leave the whole abdomen open of course.> > Karim> > > On
> 14/01/07, Roy Danks <roydanks at hotmail.com> wrote:> >> > skin open for
> small bowel? nah. Don't believe there is any literature> > addressing that.
> Colon? Definately. Moore in Denver looked at that: very> > beneficial to do
> delayed skin closure.> >> > RD> >> >> >> > > From: ldresner at gmail.com>
> Date: Sat, 13 Jan 2007 20:51:49 -0500> To:> > trauma-list at trauma.org>
> Subject: Re: small bowel injury> > one dose preop.> > none postop- i dont
> think there is a standard of > care in patients who are> > in shock postop
> though.> > leave skin open> > lisa d> suny downstate> > On> > Jan 11, 2007,
> at 10:09 PM, Roy Danks wrote:> > > small bowel? one dose.> > Colon: 24 hrs.
> I just don't know why, > > with the relative paucity of> > bacteria in the
> small bowel why more > > than one dose would be needed. If I> > do an
> elective small bowel > > resection for X disease, I don't give them> > any
> more than the > > induction antibiotic dose...I guess if you're worried> >
> about what > > went into the belly with the bullet, that's something else,>
> > but > > can't remember the last time I saw a staph infection of the belly
> >> > > after a relatively uncomplicated GSW.> >> >> Date: Thu, 11 Jan 2007>
> > 14:36:10 -0500> From: jkepros at pol.net> To: > >> trauma-list at trauma.org>>
> > Subject: Re: small bowel injury> > The > >> EAST guidelines (
> www.east.org)> > have a pretty clear recommendation > >> of> 24h for that.
> I believe you are> > correct.> John Kepros MD> > >> Michigan State
> University> > > Dear List,> >> > I was wondering if > >> you could help
> settle a friendly discussion I> >> > have with one of > >> my partners...how
> long to keep antibiotics going> >> > after small > >> bowel injury? I say no
> more than 24hr. case in point> > 40> > you s/p > >> gsw abdomen, small bowel
> resection primary anastomosis.> > Any> > > >> literature support would be
> helpful. Thanks Joe> >> >> > > >>> > ---------------------------------> >
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