Evolving concepts in the management of colonic injury

Purpose: The management of colonic injury has changed in recent years. This study sought to evaluate current surgical management of injuries to the co lon in a busy urban trauma centre, in the light of our increasing confidenc e in primary repair and evolving understanding of the concepts and practice of damage control surgery. Methods: A retrospective analysis was made of consecutive patients presenti ng with colonic injury from January I to December 31 1998. Patients without full-thickness lesions of the colon were excluded, as were patients who di ed within 24 h of admission. Demographic data, wounding patterns and clinic al course were studied. Results: One hundred twenty-seven patients were analyzed. Management withou t colostomy was achieved in 84% of cases. Patients who underwent diversion of the faecal stream had increased morbidity and hospital stay compared to equivalent patients who were repaired primarily. The important subgroup of patients who underwent damage control or abbreviated laparotomy is discusse d. Conclusion: This study further strengthens the validity of direct repair or resection and primary anastomosis for colonic injury. Strategies to deal w ith the subgroup of patients at very high risk of postoperative complicatio ns are suggested. (C) 2001 Elsevier Science Ltd. All rights reserved.