Rectum and Perineum Injuries

It is now accepted that intraperitoneal rectal injuries should be treated as abdominal colonic injuries. Therefore, this is discussed in the chapter on colonic injuries. We will focus on extraperitoneal rectal injuries. Associated lesions are common and should always be searched for based on the trauma mechanism. Historically, rectal injuries were managed with the “4 D’s”: diversion, pre-sacral drainage, direct repair, and distal washout. Damage control surgery for hemorrhage and contamination is the first priority with staged procedures for reconstruction after patient stabilization

Upper Extremity Trauma

Upper extremity traumas presented an exponential rise not only in quantity but also in complexity over the last years. Therefore, the initial approach when the patient arrives at the emergency room is very important to minimize posterior sequels of an unappropriated assessment. Initial assessment (fast and objective) facilitates the treatment, improves the final outcome, decreases the sequels, and allows an early rehabilitation. Most of the injuries occur at the same time (more than one associated injury)

Nutritional Therapy in Trauma

Organic response to trauma leads to a series of changes that culminate with an increase in catabolism, the depletion of nitrogen, and alterations in glucose and lipid metabolism, which are directly related to the intensity of trauma. The primary aim of nutritional therapy in trauma is to minimize this catabolism, avoid malnutrition, or, if the patient is already malnourished, to mitigate its effect on the healing process. Once the patient is over the immediate trauma and resuscitation is complete, the need for nutritional support should be determined immediately. The nutritional evaluation of the trauma patient is no different from that of any other surgical patient, and begins with a complete nutritional history, assessing the patient’s diet, and history of weight loss or weight gain