Bm. Renz et al., SAME ADMISSION COLOSTOMY CLOSURE (SACC) - A NEW APPROACH TO RECTAL WOUNDS - A PROSPECTIVE-STUDY, Annals of surgery, 218(3), 1993, pp. 279-293
Objective The purposes of this project were to study the healing of pr
otected rectal wounds (RWs) using contrast enemas (CEs) and to establi
sh the safety of same admission colostomy closure (SACC) in terms of c
olostomy closure (CC) and rectal wound-related outcomes, for selected
patients with radiologically healed RWs. Summary Background Data Tradi
tional treatment of RWs has included a diverting colostomy that is clo
sed 2 or more months later during a readmission. Methods All patients
admitted with a rectal injury were entered into this prospective study
, treated with a diverting colostomy and presacral drainage, and manag
ed according to a postoperative protocol that included a CE per anus t
o detect healing of the RW. Patients with no leaking on their first CE
, no infection, and anal continence underwent SACC. Results From 1990
to 1993, 30 consecutive patients had rectal injuries, 90% of which res
ulted from gunshot wounds. The first CE was performed in 29 patients 5
to 10 days after injury. In this group, 21 patients did not and 8 did
have leakage from their RWs. The proportions of RWs radiologically he
aled at 7 and 10 days after injury were 55.2% and 75%, respectively. S
ixteen patients with a normal CE underwent SACC 9 to 19 days after inj
ury (mean, 12.4 days). There were two fecal fistulas (2 of 7; 28.6%) a
fter simple suture closure, none (0 of 9) after resection of the stoma
with end-to-end anastomosis, and no RW-related complications after SA
CC. The mean hospitalization time was 17.4 days. Conclusions The follo
wing conclusions were drawn: (1) CE confirmed healing of RWs in 75% of
patients by 10 days after injury; (2) 60% of patients with RWs were c
andidates for SACC, and 53% were discharged with their colostomies clo
sed; (3) SACC was performed without complications in 87.5% of patients
with radiologically healed RWs; and (4) there were no RW-related comp
lications after SACC.