Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports
The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma...
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Korean Society of Traumatology
2022-12-01
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| Series: | Journal of Trauma and Injury |
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| Online Access: | http://jtraumainj.org/upload/pdf/jti-2022-0009.pdf |
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| author | Naa Lee Euisung Jeong Hyunseok Jang Yunchul Park Younggoun Jo Jungchul Kim |
| author_facet | Naa Lee Euisung Jeong Hyunseok Jang Yunchul Park Younggoun Jo Jungchul Kim |
| author_sort | Naa Lee |
| collection | DOAJ |
| description | The therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention. |
| format | Article |
| id | doaj-art-90488e9dd1ab4588bf0e6a4cc994ea0b |
| institution | Kabale University |
| issn | 2799-4317 2287-1683 |
| language | English |
| publishDate | 2022-12-01 |
| publisher | Korean Society of Traumatology |
| record_format | Article |
| series | Journal of Trauma and Injury |
| spelling | doaj-art-90488e9dd1ab4588bf0e6a4cc994ea0b2025-01-16T04:54:54ZengKorean Society of TraumatologyJournal of Trauma and Injury2799-43172287-16832022-12-0135429129610.20408/jti.2022.00091215Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reportsNaa Lee0Euisung Jeong1Hyunseok Jang2Yunchul Park3Younggoun Jo4Jungchul Kim5 Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, Korea Division of Trauma, Department of Surgery, Chonnam National University Hospital, Chonnam National University Medical School, Gwangju, KoreaThe therapeutic approach for colon injury has changed continuously with the evolution of management strategies for trauma patients. In general, immediate laparotomy can be considered in hemodynamically unstable patients with positive findings on extended focused assessment with sonography for trauma. However, in the case of hemodynamically stable patients, an additional evaluation like computed tomography (CT) is required. Surgical treatment is often required if prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation are observed. However, immediate intervention in hemodynamically stable patients without indications for surgical treatment remains questionable. Three patients with colon and mesocolon injuries caused by blunt trauma were treated by nonoperative management. At the time of admission, they were alert and their vital signs were stable. Colon and mesocolon injuries, large hematoma, colon wall edema, and/or ischemia were revealed on CT. However, no prominent mesenteric extravasation, free fluid, bowel infarction, and/or colon wall perforation were observed. In two cases, conservative treatment was performed without worsening abdominal pain or laboratory tests. Follow-up CT showed improvement without additional treatment. In the third case, follow-up CT and percutaneous drainage were performed in considering the persistent left abdominal discomfort, fever, and elevated inflammatory markers of the patient. After that, outpatient CT showed improvement of the hematoma. In conclusion, nonoperative management can be considered as a therapeutic option for mesocolon and colon injuries caused by blunt trauma of selected cases, despite the presence of large hematoma and ischemia, if there are no clear indications for immediate intervention.http://jtraumainj.org/upload/pdf/jti-2022-0009.pdfnonpenetrating woundsconservative treatmentcolonmesocoloncase reports |
| spellingShingle | Naa Lee Euisung Jeong Hyunseok Jang Yunchul Park Younggoun Jo Jungchul Kim Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports Journal of Trauma and Injury nonpenetrating wounds conservative treatment colon mesocolon case reports |
| title | Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports |
| title_full | Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports |
| title_fullStr | Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports |
| title_full_unstemmed | Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports |
| title_short | Nonoperative management of colon and mesocolon injuries caused by blunt trauma: three case reports |
| title_sort | nonoperative management of colon and mesocolon injuries caused by blunt trauma three case reports |
| topic | nonpenetrating wounds conservative treatment colon mesocolon case reports |
| url | http://jtraumainj.org/upload/pdf/jti-2022-0009.pdf |
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