Year 2015 Vol. 23 No 2

GENERAL AND SPECIAL SURGERY

A.V. KOCHETKOV, A.V. FEDULOVA

CLINICAL SIGNIFICANCE OF COLON INJURIES IN POLYTRAUMA IN MOTOR VEHICLE ACCIDENTS

FSBE "All-Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov of the Ministry of Emergency Situations of the Russian Federation", Saint-Petersburg,
The Russian Federation

Objectives. To study the structure and clinical significance of the colon injury in polytrauma as a result of motor vehicle accidents.
Methods. The retrospective analysis of 101 case histories of motor vehicle accidents victims with the colon injuries of 4 hospitals of St. Petersburg for the period from 1989 to 2014 has been carried out.
Results. In motor vehicle accidents the frequency of the colon injuries and its mesentery are almost identical: 53,1% and 46,8%. Cecum (10,8%), transverse colon (15,3%) and sigmoid (16,2%) were more frequently injured.
The sigmoid was injured more often in pedestrians, in victims inside the vehicle transverse colon. According to the nature of injuries, defects of the serous membrane of the colon (55%) and intramural hematoma (20,3%) were predominant ones. Complete rupture of the colon wall was observed in 18,8%. The damage of the small bowel mesentery, parenchymal organs, closed head injury, damage to the ribs, pelvic bones; lower extremities were occurred frequently in polytrauma.
Deserousive defects of the colon wall were sutured in 51,4% cases, of the mesentery in 49,5%. Colostomy in case of the damaged colon wall was applied in 5,9% cases, in case of the damaged colon mesentery 1%. In laparotomy in 97% of victims, blood loss was revealed, which was not associated with the damage to the colon. Overall mortality is composed 39 people. During traumatic shock period 36,8% of the victims died, in the second period of traumatic disease 29%, in the third period 34,2%. According to the forensic examination, the main causes of death were traumatic shock (92,3%) and hemorrhage (38,5%).
Conclusion. Colon injury is often in polytrauma however, it doesnt determine a severity of the trauma. Shock and bleeding caused by not colonic or mesenteric damage but the injury of the other anatomical regions.
Revealing colon wounds and active surgical tactics allows preventing the development of septic complications in the abdominal cavity in various phases of traumatic disease course in injured persons.

Keywords: polytrauma, blunt abdominal trauma, damage of the colon, injury of the large intestine in motor vehicle accidents, injury of mesentery, laparotomy, hemorrhage
p. 189-193 of the original issue
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Address for correspondence:
194044, Rossiyskaya Federatsiya,
g. Sankt-Peterburg, ul. Akad. Lebedeva, d. 4/2,
FGBU "Vserossiyskiy tsentr
ekstrennoy i radiatsionnoy meditsinyi im. A.M. Nikiforova MChS Rossii"
tel.: 8-911-908-11-00,
e-mail: veter-12@mail.ru,
Fedulova Anastasiya Viktorovna
Information about the authors:
Kochetkov A.V. MD, professor, a chief specialist on surgery of FSBE "All- Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov of the Ministry of Emergency Situations of the Russian Federation", professor of the general surgery chair of Military Medical Academy named after S.M. Kirov.
Fedulova A.V. A post-graduate student, surgeon of the surgical department of emergency care of FSBE "All- Russian Center of Emergency and Radiation Medicine named after A.M. Nikiforov of the Ministry of Emergency Situations of the Russian Federation".
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