IMPACT OF STOMACH AND COLON INJURIES ON INTRAABDOMINAL ABSCESS AND THE SYNERGISTIC EFFECT OF HEMORRHAGE AND ASSOCIATED INJURY

Background: Colon wounds are recognized to be highly associated with i ntra-abdominal abscess (IAA) after penetrating trauma, whereas gastric wounds are thought to contribute minimally to abscess because of the bactericidal effect of low pH, This study evaluated the impact of stom ach or colon wounds, the contribution of other risk factors, and assoc iated abdominal injuries on IAA. Methods: Patients with penetrating co lon or stomach wounds during a 10-year period were reviewed and strati fied by age, Injury Severity Score, transfusions, and associated abdom inal injuries. Early deaths (<48 hours) from hemorrhage were excluded, Outcomes analyzed were IAA and death. Results: A total of 812 patient s were identified. There were 32 late deaths (4%), of which 28% were a ttributable to IAA and multiple organ failure. IAA rates for isolated stomach or colon wounds were 0 and 4.2%, respectively. The presence of associated injuries increased IAA rates to 7.5 and 8.8%, respectively , Independent predictors of IAA determined by multivariate analysis in cluded age, transfusions, gunshot wounds, and associated injuries to t he liver, pancreas, and kidney. Conclusion: Gastric injuries are equiv alent to colon wounds in their contribution to IAA, Contamination from either organ without associated injury is minimally associated with I AA, but injury to both appears synergistic, The immunosuppressive effe cts of age and hemorrhage, in addition to significant associated injur y, enhance the development of IAA.