Primary closure in colon trauma.
BACKGROUND
Primary repair of colon injuries is an accepted therapeutic option; however, controversy persists regarding its safety. Our objective was to report the evolution and presence of complications in patients with colon injury who underwent primary closure and to determine if the time interval (>6 h), degree of injury, contamination, anatomic site injured, PATI (Penetrating Abdominal Trauma Index) >25, and the presence of other injuries in colon trauma are associated with increased morbidity and mortality.


METHODS
This was a prospective, observational, longitudinal and descriptive study conducted at the Central Hospital "Dr. Ignacio Morones Prieto," San Luis Potosí, Mexico, from January 1, 2003 to December 31, 2007. We included patients with abdominal trauma with colon injury subjected to surgical treatment. chi(2) was used for basic statistical analysis.


RESULTS
There were 481 patients with abdominal trauma who underwent surgery; 77(16.1%) had colon injury. Ninety percent (n = 69) were treated in the first 6 h; 91% (n = 70) were due to penetrating injuries, and gunshot wound accounted for 48% (n = 37). Transverse colon was the most frequently injured (38%) (n = 29). Grade I and II injuries accounted for 75.3% (n = 58). Procedures included primary repair (76.66 %) (n = 46); resection with anastomosis (8.3%) (n = 5); and colostomy (15%) (n = 9). Associated injuries were present in 76.6% (n = 59). There was some degree of contamination in 85.7% (n = 66); 82.8% (58) had PATI <25. Complications associated with the surgical procedure were observed in 28.57% (n = 22). Reoperation was necessary in 10% (n = 8). Average hospital stay was 11.4 days. Mortality was 3.8% (n = 3); none of these were related to colon injury.


CONCLUSIONS
Primary repair is a safe procedure for treatment of colon injuries. Patients with primary repair had lower morbidity (p <0.009). Surgery during the first 6 h (p <0.006) and in hemodynamically stable patients (p <0.014) had a lower risk of complications.
Salinas-Aragón
Luis Enrique
LE
Departamento de Cirugía, Hospital Central "Dr. Ignacio Morones Prieto", San Luis Potosí, San Luis Potosí, México. lesamed@hotmail.com
Guevara-Torres
Lorenzo
L
Vaca-Pérez
Enrique
E
Belmares-Taboada
Jaime Arístides
JA
Ortiz-Castillo
Fátima de Guadalupe
Fde G
Sánchez-Aguilar
Martín
M
D000007:Abdominal Injuries / Q000453:epidemiology / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis; D003106:Colon / Q000293:injuries / Q000601:surgery*; D003125:Colostomy / Q000706:statistics & numerical data; D013505:Digestive System Surgical Procedures / Q000009:adverse effects / Q000706:statistics & numerical data*; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008800:Mexico / Q000453:epidemiology; D008875:Middle Aged; D009104:Multiple Trauma / Q000453:epidemiology / Q000601:surgery; D011183:Postoperative Complications / Q000453:epidemiology / Q000517:prevention & control; D011446:Prospective Studies; D013530:Surgical Wound Infection / Q000453:epidemiology; D013536:Suture Techniques / Q000706:statistics & numerical data; D014781:Viscera / Q000293:injuries; D014946:Wound Infection / Q000188:drug therapy / Q000453:epidemiology*; D014950:Wounds, Penetrating / Q000453:epidemiology / Q000601:surgery*; D055815:Young Adult