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The American Surgeon May 2015Bowel injury (BI) is a complication of open and laparoscopic abdominal surgery associated with increased morbidity and mortality. If BI is missed at the time it occurs,... (Review)
Review
Bowel injury (BI) is a complication of open and laparoscopic abdominal surgery associated with increased morbidity and mortality. If BI is missed at the time it occurs, it can have devastating consequences. Electrosurgery is used extensively in laparoscopic surgery and can cause thermal injuries that are harder to detect than mechanical injuries and may evolve over time. The medical literature of the past 10 years was searched for large series and compilation studies reporting overall incidence of and mortality from BI in laparoscopy, and the results of seven relevant articles, which included over 300,000 procedures, were analyzed and tabulated. The literature was then reviewed for additional information about the specific incidence and outcome of missed BI and the role of electrosurgical thermal sources in causing BI. BI is underreported, frequently missed at surgery, and results in significant morbidity and mortality that can be ground for malpractice claims against the surgeon. Thermal injury from electrosurgical instruments may be involved in a number of injuries in laparoscopic surgery. Nearly undetectable partial-thickness thermal injury may play a role in the atypical and delayed presentation of some cases of BI.
Topics: Burns, Electric; Delayed Diagnosis; Humans; Intestines; Intraoperative Complications; Laparoscopy; Time Factors
PubMed: 25975332
DOI: No ID Found -
Shock (Augusta, Ga.) Jun 2015Traumatic injury remains one of the most prevalent reasons for patients to be hospitalized. Burn injury accounts for 40,000 hospitalizations in the United States... (Review)
Review
Traumatic injury remains one of the most prevalent reasons for patients to be hospitalized. Burn injury accounts for 40,000 hospitalizations in the United States annually, resulting in a large burden on both the health and economic system and costing millions of dollars every year. The complications associated with postburn care can quickly cause life-threatening conditions including sepsis and multiple organ dysfunction and failure. In addition, alcohol intoxication at the time of burn injury has been shown to exacerbate these problems. One of the biggest reasons for the onset of these complications is the global suppression of the host immune system and increased susceptibility to infection. It has been hypothesized that infections after burn and other traumatic injury may stem from pathogenic bacteria from within the host's gastrointestinal tract. The intestine is the major reservoir of bacteria within the host, and many studies have demonstrated perturbations of the intestinal barrier after burn injury. This article reviews the findings of these studies as they pertain to changes in the intestinal immune system after alcohol and burn injury.
Topics: Alcoholic Intoxication; Animals; Burns; Homeostasis; Humans; Intestinal Mucosa; Intestines
PubMed: 25692258
DOI: 10.1097/SHK.0000000000000353 -
Frontiers in Bioscience : a Journal and... Jan 2006Results from the studies discussed in this article suggest that alcohol (EtOH) intoxication is a major public health problem. While the effects of injury and EtOH... (Review)
Review
Results from the studies discussed in this article suggest that alcohol (EtOH) intoxication is a major public health problem. While the effects of injury and EtOH intoxication independent of each other have been studied in detail, only few studies have evaluated the effect of a combined insult of EtOH intoxication and burn injury on host defense. An analysis of the studies conducted in the clinical setting suggests that intoxicated patients require frequent intubations, experience delayed wound healing and longer hospital stay. Furthermore, there is a greater risk of mortality in these patients compared to those who sustained injuries in the absence of EtOH intoxication. On the other hand, there are a few studies that do not support this notion. The results obtained in experimental models clearly suggest that acute EtOH intoxication before burn injury impairs host defense and increases susceptibility to infection. Additionally, experimental data from our laboratory also indicate that EtOH intoxication before burn injury suppresses intestinal immune defense, impairs gut barrier functions and increases bacterial growth. This results in increased bacterial translocation in EtOH and burn injury. In addition, a decrease in cardiac function is also reported following a combined insult of EtOH intoxication and burn injury. Altogether, these findings suggest that EtOH intoxication before burn injury diminishes host resistance resulting in increased susceptibility to infection. Moreover, the findings of a higher incidence of infectious complications in burn and trauma patients who sustained injury in the presence of EtOH compared to those in its absence suggest that EtOH intoxication at the time of injury is a risk factor. Therefore blood EtOH should be monitored in burn/trauma patients at the time of admission in the emergency room.
Topics: Accidents; Alcohol Drinking; Alcoholic Intoxication; Animals; Bacteria; Bacterial Physiological Phenomena; Burns; Central Nervous System Depressants; Ethanol; Humans; Immune System; Intestinal Mucosa; Intestines; Myocardium
PubMed: 16146791
DOI: 10.2741/1857 -
Burns : Journal of the International... Dec 2009Gastrointestinal (GI) ileus is a common complication after severe burns. Selective cyclooxygenase-2 inhibitors (COX-2i) improved post-operative ileus, but its effect on...
Gastrointestinal (GI) ileus is a common complication after severe burns. Selective cyclooxygenase-2 inhibitors (COX-2i) improved post-operative ileus, but its effect on burn-induced GI dysmotility is unknown. Our aim was to test whether a COX-2i improves gastric emptying (GE) and small bowel transit (SBT) after burn. Experiment on GE: rats were anesthetized and randomized into sham/scald burn, treated/untreated with COX-2i. Six hours after burn, rats received a phenol red meal and were sacrificed 30 min later. Gastric emptying was determined based on the percentage of phenol red recovered in harvested stomachs. Experiment on SBT: rats received a duodenostomy and were scald/sham burned 5 days later. Six hours after burn, rats received a phenol red meal through the duodenostomy catheter and were sacrificed 100 min later. Geometric center (GC) was calculated for SBT. GE was decreased significantly in burned vs. sham animals (p<0.001). SBT was significantly impaired in burned vs. sham animals (p<0.001). The COX-2i improved GE in the burn rats but not GE in the control rats or SBT in the burn rats. COX-2i improves burn-induced delayed GE, suggesting the mediation of the latter via the prostaglandin pathway.
Topics: Animals; Burns; Cyclooxygenase 2 Inhibitors; Disease Models, Animal; Drug Evaluation, Preclinical; Gastric Emptying; Gastrointestinal Transit; Ileus; Intestine, Small; Male; Phenolsulfonphthalein; Pyrazoles; Rats; Rats, Sprague-Dawley
PubMed: 19464805
DOI: 10.1016/j.burns.2009.02.022 -
Surgery May 1978An oral prophylactic antibiotic regimen (neomycin-erythromycin-nystatin) aimed at suppression of the bowel flora was utilized in 20 patients with thermal injury treated...
An oral prophylactic antibiotic regimen (neomycin-erythromycin-nystatin) aimed at suppression of the bowel flora was utilized in 20 patients with thermal injury treated in a laminar flow burn unit with strict sterile technique and reverse isolation. The regimen was utilized for an average of 24 days. Surface cultures were obtained twice weekly from multiple areas of the burn wound, and burn wound biopsies were performed one to two times weekly. These patients were compared prospectively with a group of 10 patients treated in otherwise identical fashion, save for the omission of the antibiotic suppressive regimen. Bacterial colonization of the burn wound occurred an average of 19 days after admission in the group receiving antibiotics compared to 4 days after admission in the control group (p less than 0.01). Positive burn biopsies (more than 10(5) bacteria per gm of tissue) were observed twice as often in the group not receiving antibiotics (p less than 0.16) as were infectious complications of several types: bacteremia, burn wound sepsis, urinary tract infections, pneumonitis, cellulitis (0.10 less than p less than 0.20). Staphylococcal or fungal overgrowth were not encountered in the patients receiving prophylactic antibiotics, nor was there an adverse effect on serum creatinine levels with the prolonged use of neomycin.
Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacterial Infections; Burns; Cellulitis; Child; Child, Preschool; Erythromycin; Escherichia coli; Humans; Intestines; Middle Aged; Neomycin; Nystatin; Pneumonia; Prospective Studies; Sepsis; Staphylococcus aureus; Urinary Tract Infections
PubMed: 347612
DOI: No ID Found -
Shock (Augusta, Ga.) Oct 2023The Earth's population is aging, and by 2050, one of six people will be 65 years or older. Therefore, proper treatment of injuries that disproportionately impact people...
The Earth's population is aging, and by 2050, one of six people will be 65 years or older. Therefore, proper treatment of injuries that disproportionately impact people of advanced age will be more important. Clinical studies reveal people 65 years or older account for 16.5% of all burn injuries and experience higher morbidity, including neurocognitive decline, and mortality that we and others believe are mediated, in part, by heightened intestinal permeability. Herein, we used our clinically relevant model of scald burn injury in young and aged mice to determine whether age and burn injury cooperate to induce heightened colonic damage, alterations to the fecal microbiome, and whether resultant changes in the microbiome correlate with neuroinflammation. We found that aged, burn-injured mice have an increase in colonic lymphoid aggregates, inflammation, and proinflammatory chemokine expression when compared with young groups and sham-injured aged mice. We then performed fecal microbiota sequencing and found a striking reduction in gut protective bacterial taxa, including Akkermansia , in the aged burn group compared with all other groups. This reduction correlated with an increase in serum fluorescein isothiocyanate-Dextran administered by gavage, indicating heightened intestinal permeability. Furthermore, loss of Akkermansia was highly correlated with increased messenger RNA expression of neuroinflammatory markers in the brain, including chemokine ligand 2, TNF-α, CXC motif ligand 1, and S100 calcium-binding protein A8. Finally, we discovered that postburn alterations in the microbiome correlated with measures of strength in all treatment groups, and those that performed better on the rotarod and hanging wire tests had higher abundance of Akkermansia than those that performed worse. Taken together, these findings indicate that loss of protective bacteria after burn injury in aged mice contributes to alterations in the colon, gut leakiness, neuroinflammation, and strength. Therefore, supplementation of protective bacteria, such as Akkermansia , after burn injury in aged patients may have therapeutic benefit.
Topics: Humans; Aged; Neuroinflammatory Diseases; Dysbiosis; Ligands; Microbiota; Burns; Bacteria; Chemokines; Colon
PubMed: 37548929
DOI: 10.1097/SHK.0000000000002202 -
Orvosi Hetilap Apr 2006Infective complications play major role in mortality of high risk patients demanding intensive care. Selective Bowel Decontamination prevents endogenous infections by... (Review)
Review
Infective complications play major role in mortality of high risk patients demanding intensive care. Selective Bowel Decontamination prevents endogenous infections by reducing the number of potentially pathogen microbes (aerobic bacteria, fungi) in the oropharynx and gastrointestinal tract, saving anaerobic bacteria. It had been used 20 years ago for the first time. Authors survey it's literature ever since. Selective Bowel Decontamination is performed by the mixture of antibiotics and antimycotic drug, administered orally in hydrogel, and suspension form in nasojejunal tube. The number of Gram negative optional aerobic bacteria and fungi decrease significantly in the gut, and the microbial translocation is following this tendency. Foreign authors achieved good results in acute necrotizing pancreatitis, after liver transplant, in polytrauma, in serious burn and in haematological malignancies. According to the literature Selective Bowel Decontamination shows advantages in selected groups of high risk surgical patients. In some studies the administration took few months, but the minimum time was one week. There was no report of increasing MRSA appearance. Regular bacteriological sampling is highly recommended in order to recognize any new antibiotic resistance in time.
Topics: Bacteremia; Bacteria, Aerobic; Bacteria, Anaerobic; Burns; Fungi; Gram-Negative Bacteria; Hematologic Neoplasms; Humans; Intestines; Liver Transplantation; Methicillin Resistance; Multiple Trauma; Pancreatitis, Acute Necrotizing; Staphylococcus aureus
PubMed: 16711371
DOI: No ID Found -
Surgical Endoscopy Nov 2016Insulation defects are observed in 3-39 % of laparoscopic instruments. Electrosurgical injuries due to insulation defects or capacitive coupling remain an issue in...
BACKGROUND
Insulation defects are observed in 3-39 % of laparoscopic instruments. Electrosurgical injuries due to insulation defects or capacitive coupling remain an issue in laparoscopic surgery with a prevalence of 0.6-5 per thousand cases. Shielded instruments with active electrode monitoring (AEM) have been postulated to prevent these injuries. The benefit of these instruments has not been quantified. Most bowel injuries are unrecognized intra-operatively. Injury is revealed only after the patient exhibits peritonitis symptoms and surgical intervention to repair the bowel is required. These injuries may result in devastating and costly complications or mortality. The extent of bowel injury possible with commonly used generator settings and associated energy output has never been histologically defined. Our objectives in this experimental study were: quantify and compare the energy released through insulation defects or capacitive coupling with standard unshielded monopolar versus shielded instruments with (AEM), determine energy required to cause a visible burn, and relate the histological burn depth to a given amount of energy.
METHODS
Ex vivo porcine jejunum was used for tissue testing. An oscilloscope measured energy output from three common electrosurgical generators at recommended power settings with standard or AEM instruments with insulation defects and in capacitive coupling scenarios. Presence of a visible burn was noted, and depth of tissue damage for a given amount of energy was measured histologically.
RESULTS
All samples that received ≥3.8 J of energy had visible burns. As little as 10 J caused full wall thickness burns. 3.8 J was exceeded at the 30- and 50-W power settings in every experimental scenario using standard monopolar instruments; AEM instruments never approached this much energy.
CONCLUSIONS
Serious burn injury results from small amounts of energy leaked from standard instruments. AEM instruments appeared protective and did not leak sufficient energy to cause burn injuries to the bowel.
Topics: Animals; Burns; Electrodes; Electrosurgery; Equipment Failure; Intestines; Jejunum; Laparoscopy; Models, Anatomic; Surgical Instruments; Swine
PubMed: 27129548
DOI: 10.1007/s00464-016-4807-z -
Archives of Surgery (Chicago, Ill. :... Mar 1966
Topics: Abdominal Muscles; Burns; Female; Humans; Ileum; Infant; Skin Transplantation; Transplantation, Autologous; Transplantation, Homologous
PubMed: 4222113
DOI: 10.1001/archsurg.1966.01320210083017 -
Journal of Burn Care & Research :... Jun 2018The objective of this study was to report the case and multidisciplinary management of a 44-year-old man with 40% TBSA third- and fourth-degree burns sustained during... (Review)
Review
The objective of this study was to report the case and multidisciplinary management of a 44-year-old man with 40% TBSA third- and fourth-degree burns sustained during high-voltage electrical injury including 3 limb amputation and bowel necrosis requiring small bowel resection. This study is a case report and review of the literature. A 44-year-old man was brought to the Emergency Department with 40% TBSA third- and fourth-degree burns sustained during accidental contact with high-voltage electric current. He had multisystem injury including injuries to 3 of his extremities ultimately requiring a forequarter amputation of the left upper extremity and guillotine amputations of his bilateral lower extremities. He also sustained a visceral injury and underwent small bowel resection. While amputations are very common in electrical burn injuries, visceral electrical injuries are not. High-voltage electrical injuries are devastating multisystem insults that require multidisciplinary critical and operative care.
Topics: Adult; Amputation, Surgical; Arm Injuries; Burns, Electric; Fatal Outcome; Humans; Intestine, Small; Intra-Abdominal Hypertension; Leg Injuries; Male; Necrosis
PubMed: 28661988
DOI: 10.1097/BCR.0000000000000612