Extra Articular Pelvic Fractures with Concomitant Gastrointestinal Injury Caused by Ballistic Trauma are Harbingers of Intra-Abdominal and Retroperitoneal Abscesses

Abstract

Extra Fractures with Concomitant Gastrointestinal Injury Caused by Ballistic Trauma are Harbingers of Intra-Abdominal and Retroperitoneal Abscesses. J Emerg Med Trauma Surg Care 6: 027. Abstract Introduction: Gastrointestinal (GI) injuries with associated pelvic fractures caused by ballistic trauma result in local contamination. Recent literature has suggested that irrigation and debridement may not be necessary despite GI contamination. Although this approach my not alter the incidence of osteomyelitis, there is a lack of evidence that irrigation and debridement of bone fragments could alter the incidence of retroperitoneal and intra-abdominal abscesses. We hypothesize that contaminated and devascularized bone fragments from Extra-Articular Pelvic Fractures (EAPF) can become a nidus of recalcitrant intra-abdominal and retroperitoneal infections. The goal of this study was to examine the outcomes of contaminated EAPF in ballistic trauma managed without local irrigation and debridement. Methods: A 1-year prospective study of consecutive adult patients presenting to a Brazilian level 1 trauma center with abdominopelvic gunshot wounds and EAPF or GI injury that did not undergo operative debridement and washout of the soft tissue neighboring the fracture site. The main outcome measure was development of soft tissue infectious complication defined as peritoneal or retroperitone - al abscess. Results: A total of 82 patients were divided into 3 cohorts: A) EAPF with an associated GI injury (n=32, 39%), B) EAPF with a urological injury or no associated GI or urological injury (n=21, 26%), and C) isolated GI injury without an associated EAPF (n=29, 35%). Overall, 14 patients (17%) developed an infectious complication, 11 patients from cohort A (34%), 1 patient from cohort B (5%), and 2 patients from cohort C (7%). The odds of developing an infectious complica- tion in cohort A were 10.5 times higher compared to cohort B and 7.1 higher compared to cohort C. Cohort A was found to have significant - ly higher readmission rates and lengths of stay. Compared to other areas of the gastrointestinal tract, the odds of developing an infec- tious complication were 6 times greater for an injury to the rectum. Conclusion: GI injuries with pelvic fractures caused by ballistic trau- ma are associated with up to 10 fold increase in retroperitoneal and intra-abdominal abscesses. Future studies are needed to investigate whether, during the trauma laparotomy to repair GI injuries, irrigation and debridement of devascularized bone fragments embedded in the soft tissue would decrease the incidence of post-operative infection.