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Tue Aug 19 22:48:23 BST 2008

Ilio-sigmoid anastomosis prior to abdominal closure in multitrauma patient
A recent case at our trauma centre has raised the question of the timing and relative risks/benefits of bowel anastomosis in the multitrauma patient.

67 year old female, pedestrian hit by car, GCS 3 on scene, major head and abdominal trauma, unstable T1 fracture, multiple pelvic fractures with blush (embolized) 
Day 0: Damage control laparotomy with splenectomy, mesenteric bleed found, ~10cm small bowel resection, abdomen left open 
Day 1: Re-laparotomy with subtotal colectomy (colon found to be necrotic, sigmoid spared), iliostomy, TAC. Concurrent craniotomy for expanding extradural, and ICP monitor placement – post op continuous oozing through vac, additional re-laparotomy that afternoon for packing, VAC reapplied 
Day 4: tracheostomy and 2nd relook laparotomy for washout and primary closure 
~60 units of packed cells, 20 of FFP and 20 of cryoprecipitate transfused during these first 72 hours 
Currently GCS 4 (on day 7) 
Plan to anastomose ileum and sigmoid at later date 
Suggestion was made that anastomosis of ileum and sigmoid could have occurred during the last laparotomy prior to definitive closure, avoiding the risks of an additional laparotomy etc. Has anyone had experience with this approach? What are people’s thoughts? Thanks! Tim (Sydney, Australia)

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Ilio-sigmoid anastomosis prior to abdominal closure in multitrauma patient