Advertisement

Diseases of the Colon & Rectum

, Volume 40, Issue 6, pp 685–692 | Cite as

Civilian colon trauma

Factors that predict success by primary repair
  • Rodney M. Durham
  • Christopher Pruitt
  • John Moran
  • Walter E. Longo
Original Contributions
  • 36 Downloads

Abstract

BACKGROUND: Primary repair has become the most common method of treatment for civilian injuries of the colon. However, colostomy may still be required in selected patients. AIMS: This study was undertaken to identify factors for the performance of colostomy in patients with colon injuries. METHODS: During a 60-month period, all penetrating injuries to the colon treated at Saint Louis University Hospital were evaluated. All patients underwent an operation within six hours of injury. Rectal injuries were excluded. RESULTS: One hundred thirty consecutive patients with injuries to the colon were identified. Primary repair was performed in 81 patients (62 percent). Fecal diversion was used in 49 patients (38 percent). No deaths occurred related to colon injury. Complications related to colon injury included wound infections in 22 patients (17 percent) and intra-abdominal complications in 16 patients (abscess, 14; fecal fistula, 1). Wound complications were most closely related to whether the skin was closed primarily or left open (22vs.8 percent). Intra-abdominal complications occurred in 7 percent of patients in whom the colon injury was closed primarily and in 20 percent of patients in whom a stoma was created (P>0.05). Patients chosen for colostomy had significantly greater blood loss, more associated injuries, and higher scores on the Abdominal Trauma Index (ATI) and Colon Injury Scale (CIS) and were more likely to have gross contamination (P<0.05). Stepwise regression analysis of 13 factors revealed that only gross contamination and ATI predicted the occurrence of intra-abdominal complications and that CIS most closely predicted either wound or intra-abdominal complications. Stratification of patients based on an ATI of ≥30 and a CIS of ≥4 revealed no difference in outcome between primary repair and colostomy in either the low-risk or high-risk groups. However, severity of injury was greater in patients treated with colostomy. CONCLUSIONS: Primary repair can be accomplished with low morbidity in the majority of civilians with penetrating injuries to the colon. Colostomy may be required in high-risk patients as defined by an ATI of ≥30 in association with a CIS of ≥4.

Key words

Civilian colon trauma Primary repair Colostomy 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Nance ML, Nance FC. A stake through the heart of colostomy. J Trauma 1995;39:811.PubMedGoogle Scholar
  2. 2.
    Surgeon General Circular Letter No. 178, 1943.Google Scholar
  3. 3.
    Ivatury RR, Gaudino J, Nallathambi MN, Simon RJ, Kazigo ZJ, Stahl WM. Definitive treatment of colon injuries: a prospective study. Am Surg 1993;59:43–9.PubMedGoogle Scholar
  4. 4.
    George SM Jr, Fabian TC, Voeller GR, Kudsk JA, Mangiante EC, Britt LG. Primary repair of colon wounds. A prospective trial in nonselected patients. Ann Surg 1989;209:728–34.PubMedGoogle Scholar
  5. 5.
    Burch JM, Martin R, Richardson RJ, Muldowny DS, Mattox KL, Jordan GL. Evolution of the treatment of the injured colon in the 1980s. Arch Surg 1991;126:979–84.PubMedGoogle Scholar
  6. 6.
    Chappius CW, Frey DJ, Dietzen CD, Panetta TP, Buechter KJ, Cohn I. Management of penetrating colon injuries. Ann Surg 1991;213:492–8.Google Scholar
  7. 7.
    Nelken N, Lewis F. The influence of injury severity on complication rates after primary closure or colostomy for penetrating colon trauma. Ann Surg 1989;209:439–47.PubMedGoogle Scholar
  8. 8.
    Ridgeway CA, Frame SB, Rice JC, Timberlake GA, McSwain NE Jr, Kerstein MD. Primary repair vs. colostomy for the treatment of penetrating colon injuries. Dis Colon Rectum 1989;32:1046–9.PubMedGoogle Scholar
  9. 9.
    Sasaki LS, Allaben RD, Golwala R, Mittal VK. Primary repair of colon injuries: a prospective randomized study. J Trauma 1995;38:895–901.Google Scholar
  10. 10.
    Stone HH, Fabian TC. Management of perforating colon trauma: randomization between primary closure and exteriorization. Ann Surg 1979;190:430–6.PubMedGoogle Scholar
  11. 11.
    Moore EE, Cogbill TH, Malangoni MA. Organ injury scaling. II. Pancreas, duodenum, small bowel, colon, and rectum. J Trauma 1990;30:1427–9.PubMedGoogle Scholar
  12. 12.
    Borlase B, Moore E, Moore F. The Abdominal Trauma Index: a critical reassessment and validation. J Trauma 1990;30:1340–4.PubMedGoogle Scholar
  13. 13.
    Moore EE, Dunn EL, Moore JB. Penetrating abdominal trauma index. J Trauma 1981;21:439–45.PubMedGoogle Scholar
  14. 14.
    The Abbreviated Injury Scale, 1990. Association for the Advancement of Automotive Medicine. DesPlaines, Illinois.Google Scholar
  15. 15.
    Burch JM, Brock JC, Gevirtzman L, Mattox KL, Jordan GL, DeBakey ME. The injured colon. Ann Surg 1986;203:701–11.PubMedGoogle Scholar
  16. 16.
    Falcone RE, Wanamaker SR, Santanello SA, Carey LC. Colorectal trauma: primary repair or anastomosis with intracolonic bypassvs. ostomy. Dis Colon Rectum 1992;35:957–63.PubMedCrossRefGoogle Scholar
  17. 17.
    Sasaki LS, Mittal VK, Allaben RD. Primary repair of colon injuries: a retrospective analysis. Am Surg 1994;60:522–6.PubMedGoogle Scholar
  18. 18.
    Schultz SC, Magnant CM, Richman MF, Holt RW, Evans SR. Identifying the low-risk patient with penetrating colonic injury for selective use of primary repair. Surg Gynecol Obstet 1993;177:237–42.PubMedGoogle Scholar
  19. 19.
    Taheri PA, Ferrara JJ, Johnson CE, Lamberson KA, Flint LM. A convincing case for primary repair of penetrating colon injuries. Am J Surg 1993;166:39–44.PubMedGoogle Scholar
  20. 20.
    Shannon FL, Moore EE. Primary repair of the colon: when is it a safe alternative? Surgery 1985;98:851–9.PubMedGoogle Scholar
  21. 21.
    Thompson J, Moore E, Moore J. Comparison of penetrating injuries of the right and left colon. Ann Surg 1981;193:414–8.PubMedGoogle Scholar
  22. 22.
    Stewart RM, Fabian TC, Croce MA, Pritchard FE, Minard G, Kudsk KA. Is resection with primary anastomosis following destructive colon wounds always safe? Am J Surg 1994;168:316–9.PubMedCrossRefGoogle Scholar
  23. 23.
    Crass R, Salbi F, Trunkey D. Colostomy closure after colon injury: a low morbidity procedure. J Trauma 1987;27:1237–9.PubMedCrossRefGoogle Scholar
  24. 24.
    Pachter HL, Hoballah JJ, Corcoran TA, Hofstetter SR. The morbidity and financial impact of colostomy closure in trauma patients. J Trauma 1990;30:1510–3.PubMedCrossRefGoogle Scholar
  25. 25.
    Ryan M, Dutta S, Masri L,et al. Fecal diversion for penetrating colon injuries—still the established treatment. Dis Colon Rectum 1995;38:264–7.PubMedCrossRefGoogle Scholar

Copyright information

© American Society of Colon and Rectal Surgeons 1997

Authors and Affiliations

  • Rodney M. Durham
    • 1
  • Christopher Pruitt
    • 1
  • John Moran
    • 1
  • Walter E. Longo
    • 1
  1. 1.Department of SurgerySaint Louis University School of MedicineSt. Louis

Personalised recommendations