Prevention of infections following penetrating abdominal trauma

A major problem for patients who survive a traumatic injury is morbidity due to infectious complications; this risk increases when there is injury to the liver, pancreas, or colon, the abdominal trauma index is > 25, and/or surgery is prolonged. For major injuries of either the liver or pancreas, the use of closed suction drainage decreases the risk of infection; sump drainage should be avoided. Most penetrating colon injuries can be managed with primary repair or resection and anastomosis, unless there is an underlying medical condition or a need for massive transfusions. For gunshot wounds penetrating the colon, removal of retained missiles should be attempted because these increase the risk of abscess. A brief course of appropriate antibiotic treatment should be initiated as soon as possible after wounding and should be continued for 24 hours. Prolonged courses of antibiotic provide no added benefits.