IATROGENIC AND ACCIDENTAL COLON INJURIES - WHAT TO DO

PURPOSE: This study was designed to formulate management guidelines fo r a variety of rare iatrogenic and accidental injuries to the colon an d rectum. METHODS: This review collates the available evidence in the literature. RESULTS: Both investigative and therapeutic maneuvers invo lving the colon, particularly endoscopy and radiographic contrast stud ies, are the most common cause of significant injury although the inci dence is low. Even less common are injuries produced, at open surgery and minimally invasive surgery, by foreign bodies, enemas, or compress ed air. The mechanisms and management of these injuries are discussed in detail. CONCLUSIONS: Evidence exists to support that a nonoperative approach is safe for the majority of injuries, particularly when the colon is ''clean'' at the time of injury. Adequate resuscitation, obse rvation, and repeated reassessment are main stays of a conservative po licy. Operation is essential for progression of abdominal signs. Patie nts with established peritonitis at the time of presentation or with a n unprepared bowel are best served by prompt operation.