Universal primary colonic repair in the firearm era

All patients with colonic trauma treated at King Edward VIII Hospital, Durb an, from August 1993 to May 1994 underwent primary repair of the colonic wo und. They were evaluated prospectively to assess the mode of injury and out come variables. Colonic injuries were sustained by 102 patients. These were inflicted by gunshots (62), stabs (22), shotguns (14), and blunt trauma (4 ). The transverse colon was injured most frequently (53). All shotgun injur ies were multiple. Average time from admission to theatre was similar for s hocked and non-shocked patients. Eighty-seven patients had simple closure ( 18 deaths) and 15 required resection and anastomosis (eight deaths). Ten pa tients died in the first 48 h, and 16 died subsequently owing to multiple-o rgan systems dysfunction. The mortality rates were stabs 9% (2), gunshots 2 7% (17), shotguns 50% (7), and 0% for blunt trauma. Septic morbidity was se en in 16 but was not related to breakdown of the colonic repair. Implementa tion of strategies to reduce preoperative time delays and use damage contro l principles for the management of massive trauma should be evaluated as me thods of reducing mortality.