Applicability of an established management algorithm for colon injuries following blunt trauma.
BACKGROUND
Operative management at our institution for all colon injuries have followed a defined algorithm (ALG) based on risk factors originally identified for penetrating injuries. The purpose of this study was to evaluate the applicability of the ALG to blunt colon injuries.


METHODS
Patients with blunt colon injuries during 13 years were identified. As per the ALG, nondestructive (ND) injuries are treated with primary repair. Patients with destructive wounds (serosal tear of ≥50% colon circumference, mesenteric devascularization, and perforations) and concomitant risk factors (transfusion of >6 U packed red blood cells and/or presence of significant comorbidities) are diverted, while patients with no risk factors undergo resection plus anastomosis (RA). Outcomes included suture line failure (SLF), abscess, and mortality. Stratification analysis was performed to determine additional risk factors in the management of blunt colon injuries.


RESULTS
A total 151 patients were identified: 76 with destructive injuries and 75 with ND injuries. Of those with destructive injuries, 44 (59%) underwent RA and 29 (39%) underwent diversion. All ND injuries underwent primary repair. Adherence to the ALG was 95%: three patients with destructive injuries underwent primary repair, and five patients with risk factors underwent RA. There were three SLFs (2%) (one involved deviation from the ALG) and eight abscesses (5%). Colon-related mortality was 2.1%. Stratification analysis based on mesenteric involvement, degree of shock, and need for abbreviated laparotomy failed to identify additional risk factors for SLF following RA for blunt colon injuries.


CONCLUSIONS
Adherence to an ALG, originally defined for penetrating colon injuries, simplified the management of blunt colon injuries. ND injuries should be primarily repaired. For destructive wounds, management based on a defined ALG achieves an acceptably low morbidity and mortality rate.


METHODS
Prognostic/epidemiologic study, level III; therapeutic study, level IV.
Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee 38163, USA. jsharpe6@uthsc.edu
John P
JP
Sharpe
Louis J
LJ
Magnotti
Jordan A
JA
Weinberg
Charles P
CP
Shahan
Darren R
DR
Cullinan
Timothy C
TC
Fabian
Martin A
MA
Croce
D000328:Adult; D000465:Algorithms; D003106:Colon / Q000293:injuries* / Q000601:surgery; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*