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Wed Aug 20 05:47:23 BST 2008

Not at this time - too unstable

Tim Hardcastle
South Africa
> 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