IS RESECTION WITH PRIMARY ANASTOMOSIS FOLLOWING DESTRUCTIVE COLON WOUNDS ALWAYS SAFE

Resection with primary anastomosis was associated with a 14% anastomot ic leak rate in this review of 60 patients with destructive colon woun ds. The presence of an underlying medical illness or massive blood tra nsfusion was associated with anastomotic complications. In the high-ri sk subset of patients who had one or both of these risk factors, the a nastomotic leak rate was 42%. The incidence of anastomotic leak in pre viously healthy patients without massive transfusion was 3%. Ileocolos tomies were no safer than colocolostomies. We conclude that resection with anastomosis should not be performed on all patients with destruct ive colon injuries, as the risk of anastomotic leak is prohibitive in those with either massive blood loss or underlying medical illness. We continue to perform primary anastomosis in healthy patients without e xcessive blood loss.