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Background: Over the last 50 years, the gold standard for paediatric trauma management has grown to be non‐operative management. This study reviews a South African experience with paediatric splenic trauma in order to benchmark this against the international standard and to identify discrepancies in access to care and in surgical outcomes. Methods: This was a retrospective study conducted at a major trauma centre in South Africa. All children less than 18 years of age who were admitted to our trauma centre following trauma between December 2012 and October 2020 were identified and all those who sustained splenic trauma were reviewed. Results: Of the 66 patients reviewed, 48 (72%) were male, and the median age was 12 years (0–18 years). Thirty‐three (51%) were of rural origin and 61 (93%) sustained blunt trauma. Only eight (12%) had an isolated splenic injury, while the remaining 58 (88%) had other associated injuries. Forty‐five patients (68%) were managed non‐operatively whilst the remainder were subjected to laparotomy. Five (7%) required a splenectomy and one required angio‐embolisation. Twenty‐six patients (39%) required intensive care unit (ICU) admission: 15 (37%) in the non‐operative cohort required ICU admission and eight (40%) in the laparotomy group required ICU admission. Twenty‐eight (42%) patients required ventilatory support. Median length of stay was 5.5 days. Four (6%) patients died. Conclusions: Although non‐operative management of paediatric splenic trauma can be undertaken successfully by adult trauma surgeons in a middle‐income country such as South Africa, there remains room for improvement. To achieve splenic salvage rates comparable to those in dedicated paediatric trauma centres in high‐income countries will require systematic quality improvement programmes. [ABSTRACT FROM AUTHOR]

Background: The management of colon injuries in damage control surgery (DCS) remains controversial. Methods: A retrospective study investigating outcomes of penetrating colonic trauma in patients who survived beyond the initial repeat laparotomy (IRL) after DCS was performed. Patients over 18 years with penetrating colon injury and who underwent DCS from 2012 to 2020 were included from our electronic trauma registry. Demographic data, admission physiology and Injury Severity Score (ISS) were reviewed. Patients were classified into three groups: primary repair of non‐destructive injuries at DCL, delayed anastomosis of destructive injuries at IRL and diversion of destructive injuries at IRL. Outcomes observed included leak rates, length of intensive care unit stay, length of hospital stay, morbidities, mortality and colon‐related mortality. Results: Out of 584 patients with penetrating colonic trauma, 89 (15%) underwent DCS. After exclusions, 74 patients were analysed. Mean age was 32.8 years (SD 12.5); 67 (91%) were male. Mechanism of injury was gunshot in 63 (85%) and stab 11 (15%) patients. Seventeen patients underwent primary repair at DCS, of which one leaked. Twenty patients underwent delayed anastomosis at IRL. Of these, five (25%) developed leaks. Mortality was significantly higher for those with an anastomotic leak compared to those without (p < 0.001). Thirty‐seven patients were diverted at IRL. Overall mortality (p = 0.622) and colon‐related mortality (p = 0.592) were not significantly different across groups. Conclusion: Delayed anastomosis at IRL following DCL was associated with a leak rate of 25% in this study. When anastomotic leak did occur, it was associated with significant mortality. Delayed anastomosis should only be undertaken in highly selected patients. [ABSTRACT FROM AUTHOR]