title: The morbidity of penetrating colon injury.
abstract: 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.
authors.affiliation: Department of Surgery, Harborview Medical Center, University of Washington, Box 359796, 325 Ninth Avenue, Seattle, WA 98104, USA. ebulger@u.washington.edu
authors.forename: Eileen M
authors.initials: EM
authors.lastname: Bulger
authors.forename: Kerry
authors.initials: K
authors.lastname: McMahon
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Jurkovich
mesh_terms: 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