Indications for and outcome of primary repair compared with faecal diversion in the management of traumatic colon injury.
OBJECTIVE
Injuries of the colon are a serious sequel of abdominal trauma owing to the associated morbidity and mortality. This study aims to assess postoperative outcome and complications of faecal diversion and primary repair of colon injuries when applied according to established guidelines for the management of colon injuries.


METHODS
This retrospective study was conducted on 110 patients with colon injuries. Guided by estimation of risk factors, patients were managed either by primary repair alone, repair with proximal diversion or diversion alone.


RESULTS
There were 102 (92.7%) male patients and 8 (7.3%) female patients of median age 38 years. Thirty-seven were managed by primary repair and 73 by faecal diversion. Colon injuries were caused by penetrating abdominal trauma in 65 and blunt trauma in 45 patients. Forty-three patients were in shock on admission, and were all managed by faecal diversion. Forty patients developed 84 complications after surgery. Primary repair had a significantly lower complication rate than faecal diversion (P = 0.037). Wound infection was the commonest complication. The overall mortality rate was 3.6%.


CONCLUSIONS
Primary repair, when employed properly, resulted in a significantly lower complication rate than faecal diversion. Significant predictive factors associated with a higher complication rate were faecal diversion, severe faecal contamination, multiple colon injuries, an interval of more than 12 h after colon injury and shock.
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
E
E
Fouda
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
S
S
Emile
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
H
http://orcid.org/0000-0003-0704-4068
H
Elfeki
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
M
M
Youssef
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
A
A
Ghanem
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
A A
AA
Fikry
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
A
A
Elshobaky
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
W
W
Omar
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
W
W
Khafagy
Faculty of Medicine, Mansoura University, Mansoura, Egypt.
M
M
Morshed
D000007:Abdominal Injuries / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000714:Anastomosis, Surgical / Q000379:methods*; D002648:Child; D000066491:Clinical Decision-Making; D003106:Colon / Q000293:injuries*; D003125:Colostomy / Q000379:methods*; D013505:Digestive System Surgical Procedures / Q000379:methods; D004534:Egypt / Q000453:epidemiology; D005260:Female; D006801:Humans; D007081:Ileostomy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D019651:Plastic Surgery Procedures; D012007:Rectum / Q000601:surgery; D012189:Retrospective Studies; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000601:surgery*; D014950:Wounds, Penetrating / Q000601:surgery*; D055815:Young Adult
Colon injury; complications; diversion; indications; primary repair