April 1997

Ischemic Necrotic Bowel Disease in Thermal Injury

Author Affiliations

From the Departments of Pathology (Dr Kowal-Vern) and Surgery (Ms McGill and Dr Gamelli), and the Burn-Shock Trauma Institute (Drs Kowal-Vern and Gamelli and Ms McGill), Loyola University Medical Center, Maywood, Ill.

Arch Surg. 1997;132(4):440-443. doi:10.1001/archsurg.1997.01430280114020

Background:  Gastrointestinal tract (GI) complications are a well-recognized entity following burn injury.

Objectives:  To determine whether there was a change in the incidence and type of GI complications in individuals with thermal injuries requiring operative intervention and whether this might be related to changes in patient management.

Design:  A retrospective 8-year study of patients admitted with burn injuries.

Setting:  A university medical center burn unit.

Methods:  Statistical analysis and pathological review of 2 groups of patients: those with ischemic necrotic bowel disease (INBD group) and those with other GI complications (other GI complication group), identified among 2114 patients admitted with burn injuries during an 8-year period (1988-1995).

Results:  Of 2114 patients admitted with burn injuries, 19 patients were identified retrospectively as having had either INBD (n= 10) or other GI complications (n=9). Statistical analysis showed no difference between the 2 groups in duration of hospitalization, age, sex, pneumonia, mortality, peritonitis or gastric ulcer disease, inhalation injury, ventilator use, grafting procedures, or infections. The patients in the INBD group had a statistically significant mean (±SD) increase in the percentage of total burn surface area compared with those in the other GI complication group (53%± 10% vs 22%± 7%; P<.02) and sepsis prior to the GI complication (32% vs 5%; P<.03). A statistically significant decrease was noted in the incidence of paralytic ileus (17% vs 69%; P<.03). Enteral nutritional support became the primary mode of treatment, and GI hemorrhage and ulcer disease decreased during this period. Patients with total burn surface area greater than 40% and sepsis were at increased risk of INBD during their hospitalization.

Conclusions:  The severity of thermal injury and systemic infection are risk factors for the development of INBD. This entity is more frequent currently because of increased survival of the more severely injured patients. Systemic infection may alter the integrity of the bowel, which becomes less "tolerant" of enteral feedings. The role of large-volume high-density enteral feedings as a usually associated event in these patients remains speculative.Arch Surg. 1997;132:440-443