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colon rectum injuries

COLONIC INJURIES. AnatomyCecumAscending colonTransverse colonDescending colonSigmoid colon. COLONIC INJURIES. . EtiologyPenetrating Injury : Gun Shot ~ 75% Stab wound ~ 20% Blunt Injury : Motor vihicleTrananal Injury : Iatrogenic ; colonoscopy ,B.E. Sexual related : foreign body.

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colon rectum injuries

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    1. Colon & Rectum Injuries Prayuth Sirivongs M.D.

    3. COLONIC INJURIES Etiology Penetrating Injury : Gun Shot ~ 75% Stab wound ~ 20% Blunt Injury : Motor vihicle Trananal Injury : Iatrogenic ; colonoscopy ,B.E. Sexual related : foreign body

    4. COLONIC INJURIES Diagnosis Pre-operation Blood in rectum Acute abdomen series Water soluble contrast enema Triple contrast CT

    5. COLONIC INJURIES Intra operation Rule of “ two “ Complete mobilize Blood staining Fecal odor segmental squeeze

    6. COLONIC INJURIES Treatment Colostomy Exteriorized repair primary repair

    7. COLONIC INJURIES colostomy End Colostomy Protective Colostomy

    8. COLONIC INJURIES colostomy End Colostomy Protective Colostomy

    9. COLONIC INJURIES Indication for colostomy ( Stone & Fabian) 1.Shock c BP<80/60 mmHg 2.Intraperitoneal blood loss > 1000 ml 3.Intra-abdominal organ injuries > 2 organs 4.Significant fecal contamination 5.Time to operation >8 hrs 6.Colonic wound require resection 7.Major loss abdominal wall /Mesh

    10. COLONIC INJURIES Colonic Injury Severity score (Shanon&Moore) Grade 1 ; Serosal injury Grade 2 ; Single wall injury Grade 3 ; < 25% wall involvement Grade 4 ; > 25% wall involvement Grade 5 ; Whole colonic wall involvement and blood supply injury

    11. COLONIC INJURIES Exteriorized repair Avoided resection Reduced contamination Reduced colostomy Limited in some part of colon Stomal care is more difficult than colostomy

    12. COLONIC INJURIES Primary repair Sutured repair Resection with primary anatomosis

    13. COLONIC INJURIES Primary repair Sutured repair Resection with primary anatomosis

    14. COLONIC INJURIES Primary repair Avoid colostomy Less morbidity than colostomy Gained more popularity Having high risk in patient c underlying medical illness massive blood transfusion

    15. COLONIC INJURIES outcome cause of death exanguination sepsis ; intra- abdominal abscess multi organ failure fistula (primary repair)

    16. RECTAL INJURIES Anatomy Promontary of sacrum to anus intraperitoneal extraperitoneal Length ~12-20 cm.

    17. RECTAL INJURIES Anatomy Anal canal Anorectal ring to anal verge Sphincter complex puborectalis muscle external sphincter internal sphincter

    18. RECTAL INJURIES Etiology Penetrating injuries ; gun shot ~80% Stab & impalement <5% Blunt injury ~ 10% Transanal injury ; ~ 6% Anal intercourse Anal rape Iatrogenic ; enema, thermometer

    19. RECTAL INJURIES Diagnosis Suspected in GSW ; Trunk , buttock , perineum upper thigh Stab ; buttock , perineum , lower abdomen Blood in rectum ( rectal exam )

    20. RECTAL INJURIES Investigation X-ray pelvis & abdomen ; bullet tract,foreign body, fracture pelvis Rigid proctosigmoidoscope Water soluble contrast study

    21. RECTAL INJURIES Treatment 1.Intraperitoneal rectal injuries; as colonic injuriession 2.Extraperitoneal rectal injuries ; Diversion Debridement Distal washout Presacral drainage

    22. RECTAL INJURIES Diversion 1. Loop colostomy 2 .Loop colostomy c stapling distal lumen 3 .End colostomy c mucous fistula 4 .Hartmann’s procedure

    23. RECTAL INJURIES Diversion 1. Loop colostomy 2 .Loop colostomy c stapling distal lumen 3 .End colostomy c mucous fistula 4 .Hartmann’s procedure

    24. RECTAL INJURIES Diversion 1. Loop colostomy 2 .Loop colostomy c stapling distal lumen 3 .End colostomy c mucous fistula 4 .Hartmann’s procedure

    25. RECTAL INJURIES Diversion 1. Loop colostomy 2 .Loop colostomy c stapling distal lumen 3 .End colostomy c mucous fistula 4 .Hartmann’s procedure

    26. RECTAL INJURIES 2. Debridement : removed devitalize tissue repair defect if possible severe injury ; resection 3.Distal washout : decrease septic complication

    27. RECTAL INJURIES 4.Presacral drainage

    28. RECTAL INJURIES Outcome Cause of death: Sepsis, Multi-organ failure Anorectal abscess Rectal fistula

    29. PERINEAL INJURIES

    30. PERINEAL INJURIES

    31. PERINEAL INJURIES

    32. PERINEAL INJURIES

    33. PERINEAL INJURIES Blunt injury Straddle injury Laceration Implement Gunshot wound Blast High pressure

    34. PERINEAL INJURIES

    35. PERINEAL INJURIES

    36. PERINEAL INJURIES

    37. PERINEAL INJURIES

    38. PERINEAL INJURIES

    39. PERINEAL INJURIES

    40. PERINEAL INJURIES

    41. PERINEAL INJURIES

    42. PERINEAL INJURIES

    43. ANAL INTERCOURSE

    44. ANAL INTERCOURSE

    45. ANAL INTERCOURSE

    46. FOREIGN BODIES IN RECTUM

    47. FOREIGN BODIES IN RECTUM

    48. FOREIGN BODIES IN RECTUM

    49. FOREIGN BODIES IN RECTUM

    50. FOREIGN BODIES IN RECTUM

    51. FOREIGN BODIES IN RECTUM

    52. FOREIGN BODIES IN RECTUM

    53. Thank you for your attention

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