Management of colon wounds in the setting of damage control laparotomy: a cautionary tale.
BACKGROUND
Although colon wounds are commonly treated in the setting of damage control laparotomy (DCL), a paucity of data exist to guide management. The purpose of this study was to evaluate our experience with the management of colonic wounds in the context of DCL, using colonic wound outcomes after routine, single laparotomy (SL) as a benchmark.


METHODS
Consecutive patients during a 7-year period with full-thickness or devitalizing colon injury were identified. Early deaths (<48 hour) were excluded. Colon-related complications (abscess, suture or staple leak, and stomal ischemia) were compared between those managed in the setting of DCL versus those managed by SL, both overall and as stratified by procedure (primary repair, resection and anastomosis, and resection and colostomy).


RESULTS
One hundred fifty-seven patients met study criteria: 101 had undergone SL and 56 had undergone DCL. Comparison of DCL patients with SL patients was notable for a significant difference in colon-related complications (30% vs. 12%, p < 0.005) and suture/staple leak in particular (12% vs. 3%, p < 0.05). Stratification by procedure revealed a significant difference in colon-related complications among those that underwent resection and anastomosis (DCL: 39% vs. SL: 18%, p < 0.05), whereas no differences were observed in those who underwent primary repair or resection and colostomy.


CONCLUSIONS
Management of colonic wounds in the setting of DCL is associated with a relatively high incidence of complications. The excessive incidence of leak overall and morbidity particular to resection and anastomosis, however, give us pause. Although stoma construction is not without its own complications in the setting of DCL, it may be the safer alternative.
Weinberg
Jordan A
JA
Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama 35294-0007, USA. jweinberg@uab.edu
Griffin
Russell L
RL
Vandromme
Marianne J
MJ
Melton
Sherry M
SM
George
Richard L
RL
Reiff
Donald A
DA
Kerby
Jeffrey D
JD
Rue
Loring W
LW
D000007:Abdominal Injuries / Q000150:complications / Q000453:epidemiology / Q000601:surgery*; D000328:Adult; D000714:Anastomosis, Surgical; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003125:Colostomy; D015897:Comorbidity; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D007813:Laparotomy / Q000379:methods; D008297:Male; D008875:Middle Aged; D012773:Shock, Surgical; D055815:Young Adult