Current management of large bowel injuries and factors influencing outcome.
BACKGROUND
Colonic and intra-peritoneal rectal injuries may be managed by primary repair and extra-peritoneal rectal injuries by diverting colostomy. This study was undertaken to document our experience with this approach and to identify factors which might impact on outcome.


METHODS
Prospective study of all patients treated for colon and rectal injuries in one surgical ward at King Edward VIII hospital, Durban, over a 7-year period (1998-2004). Demographic data, clinical presentation, findings at laparotomy and outcome were documented.


RESULTS
Of 488 patients undergoing laparotomy, 177 (36%) had injuries to the colon and rectum with age 29.8+/-10.9 years. Injury mechanisms were firearms (118) stabs (54) and blunt trauma (5). Delay before laparotomy was 10+/-9.3 h. Complication and mortality rates were 36% and 17%, respectively. 68 patients (38%) required ICU management. Shock on admission and increased transfusion requirements were associated with a significantly increased mortality. Patients with delay < or = 12 h before laparotomy had a higher mortality rate than those with delay >12 h. The mortality rate increased with the number of associated injuries and it was higher the higher the Injury Severity Score (ISS); it was similar for stabs, firearms and blunt trauma. Hospital stay was 9.5+/-9.2 days.


CONCLUSIONS
We reaffirm that primary repair is appropriate for colonic and intra-peritoneal rectal injuries and that extra-peritoneal rectal injuries require diverting colostomy. Shock on admission, increased blood transfusion requirements, associated organ injury and severity of the injury were associated with high mortality.
Govender
M
M
Department of Surgery, University of KwaZulu-Natal and King Edward VIII Hospital, Durban, South Africa.
Madiba
T E
TE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D002648:Child; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003107:Colorectal Surgery / Q000379:methods / Q000639:trends; D003125:Colostomy / Q000706:statistics & numerical data; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007412:Intestinal Fistula / Q000453:epidemiology / Q000209:etiology; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D008887:Military Medicine / Q000379:methods; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000209:etiology; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D012007:Rectum / Q000293:injuries* / Q000601:surgery; D012086:Reoperation; D012307:Risk Factors; D013019:South Africa; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome; D055815:Young Adult