Ilio-sigmoid anastomosis prior to abdominal closure in multitrauma patient

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Would not do that anastomosis unless the patient was perfect and I was
closing the abdomen. Colonic anastomosis have not done well for me if the
abd remained open.
Ron simon
Dir of trauma
Bellevue Hospital Cener

-----Original Message-----
From: trauma-list-bounces at trauma.org [mailto:trauma-list-bounces at trauma.org]
On Behalf Of tim cooper
Sent: Tuesday, August 19, 2008 5:48 PM
To: trauma-list at trauma.org
Subject: Ilio-sigmoid anastomosis prior to abdominal closure in multitrauma
patient


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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