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Management of Penetrating Injury to the Left Colon

  • Trauma Surgery (J. Diaz, Section Editor)
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Abstract

Purpose of Review

Does management and outcomes of penetrating injuries to the left colon differ?

Recent Findings

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.

Summary

The majority of penetrating colon injuries can be managed safely with primary repair despite anatomic injury location as outcomes are similar.

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Fig. 1

Adapted from Trust et al. [30]

Fig. 2

Adapted from Trust et al. [30]

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Authors and Affiliations

  1. Division of Acute Care Surgery, University Hospital Cleveland Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH, 44106, USA

    Nathaniel McQuay

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  1. Nathaniel McQuay
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Correspondence to Nathaniel McQuay.

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Nathaniel McQuay declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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This article is part of the Topical collection on Trauma Surgery.

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McQuay, N. Management of Penetrating Injury to the Left Colon. Curr Surg Rep 6, 19 (2018). https://doi.org/10.1007/s40137-018-0217-6

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