Garcı́a, Alberto

Abstract Background: Penetrating diaphragmatic injuries are associated with a high incidence of posttraumatic empyema. We analyzed the contribution of trauma severity, specific organ injury, contamination severity, and surgical management to the risk of Posttraumatic empyema in patients who underwent surgical repair of diaphragmatic injuries at a level 1 trauma center.Methods: This is a retrospective review of the patients who survived more than 48 hours. Univariate OR calculations were performed to identify potential risk factors. Multiple logistic regression was used to calculate adjusted ORs and identify independent risk factors.Results: We included 192 patients treated from 2011 to 2020. There were 169 (88.0) male. The mean interquartile range, (IQR) of age was 27 (22 - 35) years. Gunshot injuries occurred in 155 subjects (80.7%). Mean (IQR) NISS and ATI were 29 (18 - 44) and 17 (10 - 27), respectively. Thoracic AIS was >3 in 38 patients (19.8%). Hollow viscus was injured in 105 cases (54.7%). Stomach in 65 (33.9%), colon in 52 (27.1%), small bowel in 42 (21.9%), and duodenum in 10 (5.2%). Visible contamination was found in 76 patients (39.6%).Potential thoracic contamination was managed with a chest tube in 128 cases (66.7%), with transdiaphragmatic pleural lavage in 42 (21.9%), and with Video Assisted Thoracoscopy Surgery or thoracotomy in 22 (11.5%). Empyema occurred in 11 patients (5.7%). Multiple Logistic Regression identified thoracic AIS >3 (OR 6.4, 95% CI 1.77 – 23. 43), and visible contamination (OR 5.13, 95% IC 1.26 – 20.90) as independent risk factors. The individual organ injured, or the method used to manage the thoracic contamination did not affect the risk of posttraumatic empyema.Conclusion: The severity of the thoracic injury and the presence of visible abdominal contamination were identified as independent risk factors of empyema after penetrating diaphragmatic trauma.

AbstractThe objective of this study was to determine the relation between the presence of a bullet (gunshot) after injury to the colon and the incidence of sepsis in its track and the soft tissue where it is retained. A retrospective review was carried out of the charts of consecutive patients admitted for abdominal gunshot wounds with proved colon injury during laparotomy where the bullet was either retained in the soft tissue or exited the body. The review covered a period of 4 years beginning January 1, 1990. Three groups were identified for analysis: (1) patients from whom the bullet was surgically removed, with additional cleansing and débridement of the area ( n= 21); (2) patients who did not undergo surgical removal of the bullet (n= 81); and (3) patients in whom the bullet exited spontaneously and in whom only débridement of the skin was carried out (n= 83). Similar risk factors were noted among the groups (age, ATI score, colostomy rate), except for a higher incidence of shock in group 3 (p= 0.003). The incidence of sepsis in soft tissue was least in group 1. It was five and seven times greater in groups 2 and 3, respectively. After an abdominal gunshot with colon injury, the missile should be removed if feasible and the local tissue débrided. If the bullet has exited spontaneously, its internal track must be débrided and lavaged extensively.