Delayed gastrointestinal reconstruction following massive abdominal trauma

Routine use of the concepts of expeditious hemostasis including the use of packing and temporizing surgical resection without anastomosis followed by delayed reexploration and reconstruction in victims of major pancreaticoduodenal trauma encouraged us to manage other devastating abdominal injuries in a similar fashion. A variety of multiple organ injuries accompanied by massive blood loss, hypothermia, and acidosis also have been managed with the philosophy that hemostasis and control of continued gastrointestinal soiling were the only necessary initial surgical procedures. Following recovery room or surgical intensive care unit stabilization with full hemodynamic resuscitation and restoration of coagulation variables to normal, delayed definitive reconstruction was done. A summary of our experience and principles of management are presented.