Primary repair for colonic gunshot wounds.
BACKGROUND
Penetrating injuries of the colon have been managed traditionally by diverting colostomy. Recently, a trend towards primary repair has been observed, particularly for knife injuries. The purpose of this study is to evaluate the safety of primary repair for colonic gunshot wounds in the presence of certain clinical risk factors.


METHODS
A retrospective analysis of 223 patients with colonic bullet injuries in a period of 3 years (1990-93) was performed.


RESULTS
Of 223 patients with colonic trauma, 168 were primarily repaired (group A) and 55 underwent a colostomy (group B). Intra-abdominal septic complications occurred in 5.9% of group A patients and 10.9% of group B patients (P > 0.05, NS). These patients were, furthermore, stratified according to well-known risk factors for the development of complications, namely, site of injury, presence of shock on admission, degree of faecal contamination and number of associated injuries. We were unable to find any statistically significant differences in intra-abdominal septic complication rates between patients treated with primary repair and patients treated with colostomy.


CONCLUSIONS
Primary repair seems to be a safe therapeutic option for gunshot wounds of the colon. Even in the presence of the above-mentioned risk factors, colostomy may be avoided in most cases as primary repair does not appear to be associated with higher complication rates.
Velmahos
G C
GC
Department of Surgery, Baragwanath Hospital, University of the Witwatersrand, Johannesburg, South Africa.
Souter
I
I
Degiannis
E
E
Hatzitheophilou
C
C
D000293:Adolescent; D000328:Adult; D002648:Child; D003082:Colectomy; D003106:Colon / Q000293:injuries* / Q000601:surgery*; D003125:Colostomy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D012774:Shock, Traumatic / Q000209:etiology / Q000401:mortality / Q000601:surgery; D013019:South Africa / Q000453:epidemiology; D014946:Wound Infection / Q000209:etiology / Q000401:mortality / Q000601:surgery; D014948:Wounds, Gunshot / Q000150:complications / Q000401:mortality / Q000601:surgery*