Low-velocity gunshot injuries of the spine with abdominal viscus trauma.

Abstract

To evaluate the risk of infection of the spine and associated complications after colonic or rectal injury associated with gunshot injury of the spine. Retrospective review. Presley Memorial Trauma Center, Regional Medical Center, Memphis, Tennessee, a statewide Level 1 trauma center. Thirty-three patients with gunshot wounds to the spine and associated viscus injury were treated between 1989 and 1994; in thirteen, the bullet passed through the colon or rectum before damaging the spine. Six patients received a single antibiotic (Cefotetan) and seven were given multiple antibiotics. Total duration of antibiotic treatment ranged from two to forty-three days. None of the thirteen patients developed osteomyelitis or disc space infection. Most intraabdominal complications were secondary to dehiscence of colonic repair. Because the magnitude of bacterial colonization of the vertebrae after colonic injury may not be high, a nonoperative approach to treatment of abdominal viscus injuries is appropriate in patients with gunshot wounds to the spine. Broad-spectrum antibiotic coverage for at least seven days appears to be effective in preventing spinal infection, but colonic injuries are associated with an increased incidence of intraabdominal abscess and peritonitis.