LIMITED ROLE OF BARIUM ENEMA EXAMINATION PRECEDING COLOSTOMY CLOSURE IN TRAUMA PATIENTS

Whether trauma patients should undergo barium enema (BE) examination o f the colon prior to colostomy closure has recently been questioned. T o ascertain the utility of BE and its impact on postoperative course i n this patient population, we reviewed 86 trauma patients who underwen t colostomy closure during a 12-year period at our institution. There were 82 males and four females with an average age of 28 years. Ninety -five percent of the injuries were the result of penetrating trauma. S ixteen patients had rectal injuries. Fifteen of these had BE greater t han 6 weeks post-trauma and all showed healing of the injury. Of the 7 0 patients with colonic injuries, 43 (group 1) had BE prior to colosto my closure. Ninety-eight percent (n = 42) of these studies were negati ve. The only positive finding did not affect the planned surgical proc edure. Group 2 (n = 27) did not have a BE prior to colostomy closure O verall complication rates were not significantly different between gro up 1 (18.6%) and group 2 (29.6%). We conclude that BE prior to colosto my closure for colonic injuries yields little useful information and d oes not affect the morbidity rate prior to colostomy closure. Its rout ine usage should be abandoned. The role of barium enema in assessing r ectal injury status is less clear because of the small number in our s eries, but probably offers no advantage over proctoscopy.