THE FATE OF COLONIC SUTURE LINES IN HIGH-RISK TRAUMA PATIENTS - A PROSPECTIVE ANALYSIS

Background: Some authors have stated that virtually all patients with penetrating colon Injuries can be safely managed with primary repair T he purpose of this study is to test the applicability of this statemen t to all trauma patients by evaluating a protocol of liberal primary r epair applied to a group of patients at high risk of septic complicati ons. Study Design: We performed a prospective analysis of a liberal po licy of primary repair applied to patients at high risk of developing postoperative septic complications admitted to a Level I urban trauma center. Inclusion criteria were full-thickness colon injury and at lea st one of three additional risk factors: 1) Penetrating Abdominal Trau ma Index (PATI) of 25 or more; 2) 6 U or more of blood transfused; and 3) 6 hours or longer elapsed between injury and surgery Results: Of 5 6 patients studied (55 male, 1 female, average age 28.8 years, mean PA TI 35.3), the vast majority had gunshot wounds as the mechanism of inj ury (89%), PATI 25 or more (95%), multiple blood transfusions (77%), a n Injury Severity Score greater than 15 (66%), and a need for postoper ative ventilatory support in the surgical intensive care unit (61%). O f 56 patients, 49 (88%) had at least one colonic suture line, and 25 p atients (45%) had destructive colon injuries requiring resection. Intr aabdominal infections occurred in 15 (27%) of 56 patients and colon su ture line disruption occurred in 3 (6%) of 49. Two of these patients d eveloped multisystem organ failure, and death was directly related to breakdown of their colonic anastomosis. Conclusions: On the basis of t hese data and the relative infrequency of patients in prospective rand omized trials with destructive colon injuries, we believe there is sti ll roam for consideration of fecal diversion in patients in high-risk categories with destructive colon injuries requiring resection. (J Am Coil Surg 1998;187:58-63. (C) 1998 by the American College of Surgeons ).