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

ABSTRACT

OBJECTIVE: To evaluate the risk of infection of the spine and associated complications after colonic or rectal injury associated with gunshot injury of the spine. DESIGN: Retrospective review. SETTING: Presley Memorial Trauma Center, Regional Medical Center, Memphis, Tennessee, a statewide Level 1 trauma center. PATIENTS 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. INTERVENTION 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. RESULTS: None of the thirteen patients developed osteomyelitis or disc space infection. Most intraabdominal complications were secondary to dehiscence of colonic repair. CONCLUSIONS: 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.