Dr Charles Meares¹, Dr Derek Liang¹, Dr Aruna  Wejiwardena¹, Prof John Vandervord¹, Dr Robert Gates¹

¹Royal North Shore Hospital, St Leonards, Australia

Abstract:

Gastrointestinal complications in the setting of burns can be severe with a mortality rate of 45% [1]. Bowel ischaemia can develop at any time during the admission [1]. Severe burns patients are at increased risk of bowel infarction due to cardiovascular effects secondary to decreased intravascular volume and massive fluid shifts. Even with appropriate fluid resuscitation in the critical care setting, bowel oedema and intraabdominal hypertension can reduce bowel venous outflow, resulting in bowel ischaemia [2]. Surgical management of bowel infarction is complicated in the setting of burns with regards to diagnosis, abdominal closure and stoma care post-operatively [1].

We report a case of a 45-year old male who developed transverse and left colon infarction with an associated large perforation of the transverse colon during an acute burn admission following a gas explosion. The patient sustained full thickness abdominal burns as part of his 78% total burn surface area. Managed in the intensive care setting whilst intubated and on vasopressor support, his acute abdomen was detected on repeat CT imaging for suspected intestinal ileus on day 12. The patient underwent urgent laparotomy for total colectomy and ileostomy through his abdominal burn. The laparotomy incision was closed with staples and the stoma secured with 4-0 PDS. Judicious post-operative wound management and stoma care was integral to achieve a functioning stoma and wound healing.

This case highlights the danger of bowel infarction in the severe burns patient and the complex issues of diagnosis, surgical management and post-operative care.

References:

[1] Markell KW, Renz EM, White CE, Albrecht ME, Blackbourne LH, Park MS, et al. Abdominal complications after severe burns. J Am Coll Surg 2009;208:940–7.

[2] Ivy ME, Possenti PP, Kepros J, Atweh NA, D’Aiuto M, Palmer J, et al. Abdominal compartment syndrome in patients with burns. J Burn Care Rehabil 1999;20:351–3.

Biography:

Charles Meares is an unaccredited trainee at Royal North Shore Hospital, Sydney.