TRAUMA DE COLON
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Transcript of TRAUMA DE COLON
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Jorge Farell Rivas
HCSAE
Pemex 2012
TRAUMA DE COLON
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ANTECEDENTES
• 2da lesión mas frecuente en trauma penetrante de abdomen.
• 5 % del trauma contuso de abdomen.
• Cambios radicales en el manejo durante los últimos 50 años.
• ¨Colostomía¨ un dogma ???
Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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MECANISMO DE LESIÓN
• Penetrante.
• HPAF
• Arma Blanca
• No penetrante : Desgarros, Estallamientos, Avulsiones.
Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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DIAGNÓSTICO
• EF :
• Poco confiable en el paciente con trauma?.
• Lesiones de retroperitoneo.
• GABINETE
• TAC ( triple contraste).
• Hallazgos : aire extraluminal, fuga de contraste, engrosamiento de pared.
Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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TRATAMIENTO
• CIERRE PRIMARIO VS COLOSTOMIA.}
• Hoy : Cierre Primario.
• 6 metanalisis lo demuestran.
• Cierre primario NO AUMENTA : Morbi-Mortalidad.
Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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TRATAMIENTO
CONTRAINDICACION PARA CIERRE PRIMARIO Y / O ANASTOMOSIS
• > 6 PG• Aminas• Múltiples lesiones abdominales asociadas• Control de daños• Edema severo de asas• Compromiso vascular
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Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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TRATAMIENTO
• COLOSTOMIA TERMINAL O EN ASA
• Casi nunca debe ser permanente.
• Preferencia en asa.
Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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Trauma. Colon and Rectum. Mattox, Feliciano. 6th edition
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CONTROL DE DAÑOS EN TRAUMA DE COLON
• Sangrado
• Infección
• Cerrar perforaciones hasta 72 hrs.
• Colostomía en abdomen abierto ???
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TRATAMIENTO.
• CIERRE DE HERIDA VS HERIDA ABIERTA
• Riesgo de infección de herida Qx es de aprox 11 a 15 %.
• Cierre de herida y vigilancia continua.
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TRATAMIENTO
• ANTIBIOTICO PROFILACTICO
• Si
• No hay necesidad de mas tratamiento
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TRATAMIENTO
• BALAS RETENIDA
• No buscar
• Riesgo de erosiones, migración e intoxicación
• No riesgo para futura RMN
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• CIERRE DE COLOSTOMÍA
• 4 a 6 semanas
• < 7 días ?? Ó misma hospitalización
• Complicaciones
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