Colon Traumatic Injuries - Factors that Influence Surgical Management
G. Jinescu, I. Lica, M. BeuranOriginal article, no. 5, 2013
Background: This study sought to evaluate current trends insurgical management of colon injuries in a level I urbantrauma centre, in the light of our increasing confidence inprimary repair.Methods: Our retrospective study evaluates the results of 116patients with colon injuries operated at Bucharest ClinicalEmergency Hospital, in the light of some of the mostcommonly cited factors which could influence the surgeondecision-making process towards primary repair or colostomy.Results: Blunt injuries were more common than penetratinginjuries (65% vs. 31%). Significant other injuries occurred in85 (73%) patients. Primary repair was performed in 95patients (82%). Fecal diversion was used in 21 patients(18%). Multiple factors influence the decision-makingprocess: shock, fecal contamination, associated injuries andhigher scores on the Abdominal Trauma Index (ATI) andColon Injury Scale (CIS). Colon related intra-abdominalcomplications occurred in 7% of patients in whom thecolon injury was closed primarily and in 14% of patients inwhom a stoma was created, ATI having a predictive role intheir occurrence. The overall mortality rate was 19%.Conclusions: Primary repair of colon injuries, either by primarysuture or resection and anastomosis, is a safe method in themanagement of the majority of colonic injuries. Colostomy is preferred for patients with ATI ė 30 and CIS ė 4. Surgicaljudgment remains the final arbiter in decision making.
