Evolving concepts in the management of colonic injury.
OBJECTIVE
The management of colonic injury has changed in recent years. This study sought to evaluate current surgical management of injuries to the colon in a busy urban trauma centre, in the light of our increasing confidence in primary repair and evolving understanding of the concepts and practice of damage control surgery.


METHODS
A retrospective analysis was made of consecutive patients presenting with colonic injury from January 1 to December 31 1998. Patients without full-thickness lesions of the colon were excluded, as were patients who died within 24 h of admission. Demographic data, wounding patterns and clinical course were studied.


RESULTS
One hundred twenty-seven patients were analyzed. Management without 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 discussed.


CONCLUSIONS
This study further strengthens the validity of direct repair or resection and primary anastomosis for colonic injury. Strategies to deal with the subgroup of patients at very high risk of postoperative complications are suggested.
Bowley
D M
DM
Johannesburg Hospital Trauma Unit, Area 378, Johannesburg Hospital, Private Bag x39, 2000, Johannesburg, South Africa.
Boffard
K D
KD
Goosen
J
J
Bebington
B D
BD
Plani
F
F
D000063:Accidents, Traffic; D000293:Adolescent; D000328:Adult; D000714:Anastomosis, Surgical / Q000009:adverse effects / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003125:Colostomy / Q000009:adverse effects / Q000706:statistics & numerical data; D017577:Cutaneous Fistula / Q000209:etiology; D005260:Female; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D017792:Surgical Stapling / Q000706:statistics & numerical data; D013529:Surgical Wound Dehiscence / Q000209:etiology; D013530:Surgical Wound Infection / Q000209:etiology; D016896:Treatment Outcome; D014948:Wounds, Gunshot / Q000601:surgery*; D014951:Wounds, Stab / Q000209:etiology / Q000601:surgery*