SAME ADMISSION COLOSTOMY CLOSURE (SACC) - A NEW APPROACH TO RECTAL WOUNDS - A PROSPECTIVE-STUDY

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.