The Bowel: Contamination, Colostomies, and Combat Surgery

Abstract

Traumatic bowel injury in the combat casualty is extremely common and you must be comfortable with its management. Luckily, despite all that is written, the basic principles that govern the operative management for traumatic bowel injury boil down to control of hemorrhage and contamination, assessment of bowel viability, determination of need to resect vs. repair, and choice of reconstruction. Combat casualties tend to present with a multitude of injuries from combined mechanisms, so they must often be managed through means not typical of civilian trauma surgery. This is not the setting or the patient population to “try out” some great new technique you just read about or to push the envelope of primary reconstruction. While there are many ways to “skin a cat”, we will present you with some techniques and advice that we found useful in the management of these complex injuries.

Deployment Experience:

Eric K. JohnsonStaff Surgeon, 10th Combat Support Hospital, Baghdad, Iraq 2005–2006

Task Force Surgeon, US Special Operations Command, Afghanistan, OEF 2007, Iraq, OIF, 2008

Scott R. SteeleStaff Surgeon, 47th Combat Support Hospital, Tikrit, Iraq, 2006

745th Forward Surgical Team, Amarah, Iraq 2008