Abstract
Purpose
Several factors have been considered important for the decision between diversion and primary repair in the surgical management of colorectal injuries. The aim of this study is to clarify whether patients with colorectal injuries need diversion or not.
Methods
From 2008 to 2010, ten patients with colorectal injuries were surgically treated by primary repair or by a staged repair.
Results
The patients were five men and five women, with median age 40 years (20–55). Two men and two women had rectal injuries, while 6 patients had colon injuries. The mechanism of trauma in two patients was firearm injuries, in two patients was a stab injury, in four patients was a motor vehicle accident, in one woman was iatrogenic injury during vaginal delivery, and one case was the transanal foreign body insertion. Primary repair was possible in six patients, while diversion was necessary in four patients.
Conclusions
Primary repair should be attempted in the initial surgical management of all penetrating colon and intraperitoneal rectal injuries. Diversion of colonic injuries should only be considered if the colon tissue itself is inappropriate for repair due to severe edema or ischemia. The role of diversion in the management of unrepaired extraperitoneal rectal injuries and in cases with anal sphincter injuries is mandatory.
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References
Papadopoulos VN (2010) Surgical management of colon and rectum injury. Surg Chron 15:92–104
Brasel KJ, Borgstrom DC, Weiglet JA et al (1999) Management of penetrating colon trauma: a cost utility analysis. Surgery 125:471–479
Conrad JK, Ferry KM, Foreman ML et al (2000) Changing management trends in penetrating colon trauma. Dis Colon Rectum 43:466–471
Thomson SR, Baker A, Baker LW et al (1996) Prospective audit of multiple penetrating injuries to the colon further support for primary repair. J R Coll Surg Ed 41:20–24
Nelken N, Lewis F (1989) The influence of injury severity on complication rates after primary closure or colostomy for penetrating colon trauma. Ann Surg 209:439–447
Sasaki LS, Mittal V, Allaben RD (1994) Primary repair of colon injuries: a retrospective analysis. Am Surg 60:522–527
Ivatury RR, Guadino J, Nallathambi MN et al (1993) Definitive treatment of colon injuries: a prospective study. Am Surg 59:43–49
Sasaki LS, Allaben RD, Golwala R, Mittal V (1995) Primary repair of colon injuries: a prospective randomized study. J Trauma 39:895–901
Gonzalez RP, Holevar MR, Falimirski ME, Merlotti GJ (1997) A method for management of extraperitoneal pelvic bleeding secondary to penetrating trauma. J Trauma 43:338–341
Joe D (2009) Colonic trauma: indications for diversion vs repair. J Gastrointest Surg 13:403–404
Chappuis CW, Frey DJ, Dietzen CD et al (1991) Management of penetrating colon injuries: a prospective randomized trial. Ann Surg 213:492–498
Gonzalez RP, Turk B (2002) Surgical options in colorectal injuries. Scand J Surg 91:87–91
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The authors certify that there is no actual or potential conflict of interest in relation to this article.
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Papadopoulos, V.N., Michalopoulos, A., Apostolidis, S. et al. Surgical management of colorectal injuries: colostomy or primary repair?. Tech Coloproctol 15 (Suppl 1), 63–66 (2011). https://doi.org/10.1007/s10151-011-0734-0
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DOI: https://doi.org/10.1007/s10151-011-0734-0