The morbidity of penetrating colon injury.
The purpose of this study is to define the current morbidity and mortality associated with penetrating colon injury and to determine the impact of management strategy on outcome.


METHODS
A retrospective review was performed of all penetrating colon injuries managed at a level I trauma center (1990-2000), n=186. Stepwise logistic regression was used to determine the independent predictors for colostomy and morbidity following colon injury.


RESULTS
Fifty-three percent of the patients were managed with primary repair or anastomosis while 47% received a colostomy. Independent predictors of colostomy included gunshot wound (GSW), degree of peritoneal contamination, and location of injury. The complication rate for patients requiring a colostomy was 57% versus 42% for the primary repair group, P=0.01. When adjusted for injury severity and hypotension, the presence of a colostomy was not associated with a significant increase in the complication rate (OR 1.7, 95% CI: 0.9-3.25). Independent predictors for the development of intra-abdominal abscess were hypotension on admission (OR 2.4, 95% CI: 1.1-5.8) and penetrating abdominal trauma index (PATI) score >25 (OR 4.2, 95% CI: 2.0-8.9). The complication rate for colostomy takedown was 17%.


CONCLUSIONS
Penetrating colon injury carries a high rate of infectious morbidity. The development of infectious complications is related to the injury severity and haemodynamic status of the patient, not the type of operation performed.
Bulger
Eileen M
EM
Department of Surgery, Harborview Medical Center, University of Washington, Box 359796, 325 Ninth Avenue, Seattle, WA 98104, USA. ebulger@u.washington.edu
McMahon
Kerry
K
Jurkovich
Gregory J
GJ
D018784:Abdominal Abscess / Q000209:etiology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003125:Colostomy / Q000009:adverse effects / Q000379:methods; D005260:Female; D006801:Humans; D007239:Infections / Q000209:etiology / Q000401:mortality*; D015601:Injury Severity Score; D016015:Logistic Models; D008297:Male; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality*; D012189:Retrospective Studies; D014861:Washington / Q000453:epidemiology; D014950:Wounds, Penetrating / Q000150:complications / Q000401:mortality* / Q000601:surgery