Management of Penetrating Injury to the Left Colon
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Purpose of Review
Does management and outcomes of penetrating injuries to the left colon differ?
Management pendulum has swung from non-operative management during the Civil War era, to mandatory exploration and fecal diversion by WWII. Continuing advancements in medical management, anesthesia, and surgical techniques have led to the transition from mandatory fecal diversion to primary repair. Civilian trauma experience further supported this paradigm shift with identification of risk factors better defining the role of primary repair. Patients with non-destructive injuries benefited from primary repair, while in those with destructive injuries, resection, and anastomosis is recommended. Injury location historically has been managed with the bias of left-sided colonic injuries mandating fecal diversion due to concerns for increased complications. Evolving literature contradicts such logic as colonic related outcomes appear similar.
The majority of penetrating colon injuries can be managed safely with primary repair despite anatomic injury location as outcomes are similar.
KeywordsPenetrating trauma Colon injury Damage control Anastomotic leak Primary repair Fecal diversion
Compliance with Ethical Guidelines
Conflict of interest
Nathaniel McQuay declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Recently published papers of particular interest have been highlighted as: ∙ Of importance
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