ECMO-/ECLS

approach for repair is a reasonable alternative to a traditional midline
laparotomy. In penetrating traumas, initial local wound exploration to identify
penetration of the anterior abdominal fascia is recommended. If local
exploration shows that peritoneum has been violated or if the exploration has
equivocal finding , then laparoscopy can be performed to determine peritoneal
penetration. [9, 45, 46].^ Regardless of the approach, principles of management
of hollow viscus injury include prompt resuscitation, complete removal of
devitalized tissue, reconstruction or diversion of the intestinal tract, and
perioperative antibiotic coverage.
When the small intestine is the portion of the intestine that has been
injured, it can nearly always be resected with subsequent primary anastomosis
performed even in the presence of significant contamination. For colonic
injuries, a primary repair should be performed in all cases of minimal
contamination, and even in most cases with significant contamination.
However, in the setting of significant devitalizing colonic injury in a patient in
shock, initial damage control laparotomy is recommended with delayed colonic
anastomosis at the time of abdominal wall closure. In this scenario, a higher
complication rate has been found with delayed anastomosis if fascial closure
occurs greater than 5 days after injury and in the case of a left colonic injury
[47]. A diverting colostomy rather than a delayed anastomosis should be
performed at the time of abdominal wall closure in patients with recurrent intra-
abdominal abscesses, severe bowel wall edema and inflammation, or
persistent metabolic acidosis [48].