A decade long overview of damage control laparotomy for abdominal gunshot wounds.

Purpose: Over the last three decades, damage control laparotomy (DCL) has become important in the management of abdominal gunshot wounds (GSW). This paper reviews the experience of a single institution over a decade with the use of DCL for GSW of the abdomen.

Methods: Longitudinal data (2013-2022) was collected from the Hybrid Electronic Medical Registry database to identify all patients with an abdominal GSW over the study period.

In-Hospital Mortality Following Traumatic Injury in South Africa.

Unlabelled: Trauma is a leading cause of death worldwide and in South Africa. We aimed to quantify the in-hospital trauma mortality rate in Pietermaritzburg, South Africa.

Background: The in-hospital trauma mortality rate in South Africa remains unknown, and it is unclear whether deficits in hospital care are contributing to the high level of trauma-related mortality.

Trauma to the gallbladder is associated with concurrent injuries to the extra hepatic biliary system: A South African experience.

Introduction: Gallbladder trauma is a rare injury. This study aimed to describe the significance of these injuries and the appropriate management strategies.

Methods: A retrospective study was undertaken at a major trauma centre in South Africa and included all patients diagnosed with a gallbladder injury between January 2012 and October 2020.

Liver trauma: WSES 2020 guidelines.

Liver injuries represent one of the most frequent life-threatening injuries in trauma patients. In determining the optimal management strategy, the anatomic injury, the hemodynamic status, and the associated injuries should be taken into consideration. Liver trauma approach may require non-operative or operative management with the intent to restore the homeostasis and the normal physiology.

Contemporary management of rectal trauma - A South African experience.

Introduction: The management of rectal trauma remains controversial. There are three modalities which have been used to manage these injuries; proximal diversion (PD), washout of the distal rectum (DRW) and presacral drainage (PSD). The EAST group tentatively advocate mandatory proximal diversion for extraperitoneal rectal injuries and omitting DRW or PSD.

Duodeno-pancreatic and extrahepatic biliary tree trauma: WSES-AAST guidelines.

Duodeno-pancreatic and extrahepatic biliary tree injuries are rare in both adult and pediatric trauma patients, and due to their anatomical location, associated injuries are very common. Mortality is primarily related to associated injuries, but morbidity remains high even in isolated injuries. Optimal management of duodeno-bilio-pancreatic injuries is dictated primarily by hemodynamic stability, clinical presentation, and grade of injury.

Feasibility and Clinical Outcome of Reboa in Patients with Impending Traumatic Cardiac Arrest.

Background: Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) may improve Systolic Blood Pressure (SBP) in hypovolemic shock. It has, however, not been studied in patients with impending traumatic cardiac arrest (ITCA). We aimed to study the feasibility and clinical outcome of REBOA in patients with ITCA using data from the ABOTrauma Registry.

Kidney and uro-trauma: WSES-AAST guidelines.

Renal and urogenital injuries occur in approximately 10-20% of abdominal trauma in adults and children. Optimal management should take into consideration the anatomic injury, the hemodynamic status, and the associated injuries. The management of urogenital trauma aims to restore homeostasis and normal physiology especially in pediatric patients where non-operative management is considered the gold standard.

Developing a blueprint for a civilian-military collaborative program in trauma training for Northern European countries: A South African experience.

Background: Recent terrorist attacks and mass shooting incidents in major European and North American cities have shown the unexpected influx of large volumes of patients with complex multi-system injuries. The rise of subspecialisation and the low violence-related penetrating injuries among European cities, show the reality that most surgical programs are unable to provide sufficient exposure to penetrating and blast injuries. The aim of this study is to describe and create a collaborative program between a major South African trauma service and a NATO country military medical service, with synergistic effect on both partners.

Damage control or definitive repair? A retrospective review of abdominal trauma at a major trauma center in South Africa.

Background: This study set out to review a large series of trauma laparotomies from a single center and to compare those requiring damage control surgery (DCS) with those who did not, and then to interrogate a number of anatomic and physiologic scoring systems to see which best predicted the need for DCS.

Methods: All patients over the age of 15 years undergoing a laparotomy for trauma during the period from December 2012 to December 2017 were retrieved from the Hybrid Electronic Medical Registry (HEMR) at the Pietermaritzburg Metropolitan Trauma Service (PMTS), South Africa. They were divided into two cohorts, namely the DCS and non-DCS cohort, based on what was recorded in the operative note.

Defining an intra-operative blunt mesenteric injury grading system and its use as a tool for surgical-decision making.

Background: The mesentery may be injured in trauma and few grading systems describe mesenteric injury severity. We aimed to develop and validate an intra-operative mesenteric injury grading system.

Methods: A modified Delphi technique was used to generate an intraoperative grading system for blunt mesenteric injury called the mesenteric injury score (MIS).

Management of intra-abdominal vascular injury in trauma laparotomy: a South African experience.

Background: Intra-abdominal vascular injury (IAVI) is uncommon but continues to be associated with high mortality rates despite technological advances in the past decades. In light of these ongoing developments, we reviewed our contemporary experience with IAVI in an attempt to clarify and refine our management strategies and the outcome of these patients.

Methods: We retrospectively reviewed the charts of all patients admitted between January 2011 and December 2014 at a major trauma centre in South Africa who were found to have an IAVI during laparotomy for trauma.