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PubMed1997

Imperforate anus (anal agenesis) with rectal and sigmoid atresias in a newborn.

A male baby was born to a healthy mother after an uncomplicated 39-week pregnancy. He had finger and toe syndactyly, right hemidiaphragm eventration, and a high imperforate anus (anal agenesis). The kidneys and chromosomes were normal. A right transverse colostomy was done and 5 months later he underwent a posterior sagittal anorectoplasty (Pena procedure). An intermediate imperforate anus with no urethral fistula and a rectal atresia 2 cm proximal to the distal rectal pouch were found; the distal rectal pouch was resected and the standard Pena procedure completed. Dilatations were initiated 2 weeks postoperatively and continued until the colostomy was closed. Prior to closure of the colostomy, a distal colon loopogram demonstrated an obstruction in the sigmoid; constrast introduced via the rectum outlined the same obstruction separated by 2 cm. A low sigmoid atresia was then repaired. Three weeks later, a contrast loopogram showed a narrow but intact rectosigmoid anastomois, and the colostomy was closed. The anorectal dilatations were discontinued and he remains well at 7 years of age.

Abnormalities, Multiple↗
PubMed1986

The missing randomized trial of two surgical treatments for acute obstruction due to carcinoma of the left colon and rectum. An interim report.

Between 1978 and 1985, 55 patients with left-sided colonic obstruction presenting as an emergency were randomised to two treatment groups. In Group T (28 patients) a transverse colostomy was performed as a first stage. After recovery, a second stage of resection with anastomosis was carried out and 17 patients had a 'curative' resection. Of these the colostomy was closed as a third stage in 16. In Group R (27 patients) immediate resection with end colostomy and mucous fistula was carried out as a first stage. A 'curative' resection was possible in 25, of whom 5 died postoperatively. Of the 20 remaining patients, 15 underwent a second stage operation in which reanastomosis was carried out. There was no significant difference in cancer-specific survival between the two treatment groups. Six patients having a curative operation in Group T died with recurrence and 1 further death occurred unrelated to cancer, leaving 10 alive at present, 3 of whom have recurrence. Of the 25 patients treated for cure in Group R, 5 died postoperatively, 9 died with recurrence and 11 were still alive at the time of this assessment, 1 of whom has recurrence. The results at this intermediate stage of assessment indicate no advantage for immediate resection in terms of treatment mortality and long-term survival over an initial transverse colostomy.

Acute Disease↗
PubMed1987

A comparison of emergency resection and staged management in perforated diverticular disease.

This retrospective view examines the outcome of surgical treatment of perforated diverticular disease in one hospital in the period 1976 to 1983. Of the 78 patients, 38 underwent emergency colonic resection (group A) whereas 40 (group b) were treated by proximal colostomy and drainage (37 patients) or suture of the perforation with drainage (three patients). There was no significant difference between groups A and B in terms of operative mortality (21 percent vs. 24 percent, respectively). Mortality rates were highest in patients with generalized peritonitis treated by colostomy and drainage (36 percent), whereas those with localized disease undergoing resection had a mortality rate of 17 percent (P less than .05). Eight of the 40 patients in group B developed fistulas whereas none of the group A patients had this complication. Only four (16 percent) of the surviving group A patients were left with a permanent colostomy as opposed to 15 (56 percent) of their counterparts in group B. In the presence of perforated diverticular disease, emergency resection carries a lower morbidity than colostomy and drainage, although the present review shows no statistically significant differences in terms of mortality.

Adult↗
PubMed2004

A ten-year study of penetrating injuries of the colon.

BACKGROUND: Colon injury has been associated with a high risk of septic complications and mortality. We prospectively studied the pattern, management, outcome, and prognostic factors in patients who sustained penetrating colon injuries. PATIENTS AND METHODS: Sixty patients who presented to our hospital with penetrating colon injuries over a ten-year period (1992 to 2001) were studied. RESULTS: Colon wounds were caused by gunshots in 55 (91.7 percent) patients and knife stabs in 5 (8.3 percent). There was a delay of more than 12 hours before laparotomy in 30 (50 percent) patients. Moderate or major fecal contamination of the peritoneal cavity occurred in 58 (96.7 percent) patients. The average penetrating abdominal trauma index score was 25.9 and 20 (33.3 percent) patients sustained Flint Grade 3 colon injury. Associated intra-abdominal injuries occurred in the small bowel (73.3 percent), liver (25 percent), stomach (23.3 percent), and mesentery (16.7 percent). Right colon wounds (35) were managed by primary repair in 24 (68.6 percent) patients and proximal diverting colostomy in 11 (31.4 percent), whereas left colon wounds (25) were managed by diverting colostomy in 22 (88.0 percent) patients and primary repair in 3 (12.0 percent) patients. Common complications included wound infection (56.7 percent), septicemia (31.7 percent), and enterocutaneous fistula (16.7 percent). The overall mortality rate was 33.3 percent and colon injury-related mortality was 21.7 percent. Presence of destructive colon injury was associated with a greater than fourfold increased incidence of death. Other significant risk factors included shock on admission, major fecal contamination, duration of operation more than four hours, penetrating abdominal trauma index score >25, and more than two postoperative complications. There was no difference in outcome between patients who had primary repair and those undergoing diverting colostomy. Colostomy closure-related morbidity was 21 percent and mortality was 5.3 percent. CONCLUSION: A more liberal use of primary repair is required in our patients with penetrating injuries of the colon.

Adolescent↗
PubMed1986

Surgical treatment of radiation injuries of the colon and rectum.

Between 1950 and 1983, radiation-induced proctitis was diagnosed proctoscopically in 720 patients at the Mayo Clinic. Sixty-two patients with severe colorectal symptoms were treated surgically. The interval from cessation of radiotherapy to onset of symptoms ranged from 3 weeks to 24 months (mean 33 months). The 62 patients underwent a total of 143 operations with 8 operative deaths (13 percent), and 40 patients (65 percent) had 61 complications. The morbidity rate was lower after colostomy alone (44 percent in 27 patients) than after more aggressive operations (80 percent in 35 patients). Transverse loop colostomy and descending colostomy were safer than sigmoid colostomy. The dissection adhesions, opening of tissue planes, and careless manipulation of intestine may result in necrosis and perforation of the intestine, bladder, or vaginal wall; these were the main causes of fecal and other internal fistulas in our study.

Cecum↗
PubMed1987

Incidence of fecal incontinence after coloproctostomy below five centimeters in the rectum.

Anastomosis of the descending colon to the rectum below 5 cm can result in fecal incontinence. We have reviewed 90 patients who underwent radical resection of the rectosigmoid colon with very low anastomosis that healed; 88 patients resumed defecation per anus. Indications for the resections were recurrent squamous cell carcinoma after total pelvic irradiation, adenocarcinoma of the endometrium with invasion of the mesentery of the rectosigmoid colon, endometriosis with low rectal involvement, and serous carcinoma of the ovary with invasion of the rectosigmoid mesentery and irradiation stenosis of the rectum. The rectum was transected at the level of the levator ani or below resulting in less than 5 cm of rectum above the anus. All patients had reanastomosis, coloproctostomy, with the end-to-end anastomosis stapler. All coloproctostomies were protected by proximal diverting colostomy if one of three conditions existed: (a) total pelvic irradiation; (b) significant diverticulitis or other inflammatory bowel disease; and (c) inadequate or unprepared bowel at the time of surgery. The proximal diverting colostomies were closed 8-16 weeks postoperatively after demonstrable healing of the anastomosis. Of the 90 patients, 88 eventually resumed defecation per anus after coloprotostomies and 5 (5%) required replacement of the colostomy for fecal incontinence. Eighty-three patients (92%) had successful reanastomosis, closure of the proximal colostomy, and defecation per rectum without fecal incontinence.

Aged↗
PubMed2003

Which stoma works better for colonic dysmotility in the spinal cord injured patient?

BACKGROUND: The formation of an intestinal stoma is very effective in the treatment of colonic dysmotility associated with spinal cord injury (SCI). Little is known about the difference in the long-term outcome among left-sided colostomies, right-sided colostomies, and ileostomies in this patient population. METHODS: The records of 45 SCI patients with intestinal stomas at our institution were reviewed retrospectively. Operative details and preoperative colonic transit times (CTT) were recorded. Patients who were alive and available were interviewed using a questionnaire designed to assess the quality of life (QOL), health status, and time to bowel care before and after stoma formation. RESULTS: Between 1976 and 2002, 45 patients underwent a total of 48 intestinal stomas. A left-sided colostomy (LC) was formed in 21 patients, right-sided colostomy (RC) in 20, and ileostomy (IL) in 7. Three of the patients in the RC group ultimately underwent total abdominal colectomy and ileostomy. The indications for stoma formation and CTT were different in the three groups. Bloating, constipation, chronic abdominal pain, difficulty evacuation with prolonged CTT was the main indication in 95% of patients in the RC group, 43% of patients in the LC group, and 29% in the IL group. Management of complicated decubitus ulcers, perineal and pelvic wounds was the primary indication in 43% of patients in the LC group, 5% in the RC group, and none in the IL group. Preoperative total and right CTTs were longer in the RC group compared with the LC group: 127.5 versus 83.1 hours (P <0.05) and 53.7 versus 28.5 hours (P <0.05), respectively. Eighty-two percent of patients (37 of 45) were interviewed at a mean follow-up of 5.5 years after stoma formation. Most patients who were interviewed were satisfied with their stoma (RC, 88%; LC, 100%; IL, 83%) and the majority would have preferred to have the stoma earlier (RC, 63%; LC, 77%; and IL, 63%). The QOL index significantly improved in all groups (RC, 49 to 79, P <0.05; LC, 50 to 86, P <0.05; and IL, 60 to 82, P <0.05), as well as the health status index (RC, 58 to 83, P <0.05; LC, 63 to 92, P <0.05; IL, 61 to 88, P <0.05). The average daily time to bowel care was significantly shortened in all groups (RC, 102 to 11 minutes, P <0.05; LC, 123 to 18 minutes, P <0.05; and IL, 73 to 13 minutes, P <0.05.). CONCLUSIONS: Regardless of the type of stoma, most patients had functional improvement postoperatively. Patients who underwent RC had longer CTT and more chronic symptoms related to colonic dysmotility, reflecting the preoperative selection bias. The successful outcome noted in all groups suggests that preoperative symptoms and CTT studies may have been helpful in optimal choice of stoma site selection.

Colonic Diseases, Functional↗
PubMed2004

The timing of elective colectomy in diverticulitis: a decision analysis.

BACKGROUND: Determining the optimal strategy for elective colectomy in patients with diverticular disease involves a balance of the morbidity, mortality, costs, and quality of life associated with both elective and expectant management. We used decision and cost analysis to simulate the clinical and economic outcomes after recovery from an episode of nonsurgically treated diverticulitis to determine the preferable management strategy. STUDY DESIGN: A Markov model was constructed to evaluate lifetime risks of death and colostomy, care costs, and quality of life associated with elective colectomy after subsequent episodes of diverticulitis. The analysis was from the payer's perspective, using hypothetical cohorts of 35- and 50-year-old patients who recovered from a nonsurgically treated diverticulitis episode. Probabilities of clinical events and costs for the base-case analysis were derived from a large cohort using a statewide administrative database and published estimates. RESULTS: Performing colectomy after the fourth rather than the second episode in patients older than 50 years resulted in 0.5% fewer deaths, 0.7% fewer colostomies, and saved US 1,035 dollars per patient. In younger patients, performing colectomy after the fourth episode compared with the first episode resulted in 0.1% fewer deaths, 2% fewer colostomies, and saved US 5,429 dollars per patient. Expectant management through three recurrent episodes with elective colectomy after the fourth episode was the dominant strategy across the full range of the variables tested in the sensitivity analysis compared with earlier intervention. CONCLUSIONS: This study suggests that expectant management is associated with lower rates of death and colostomy and is cost-saving for both younger and older patients.

Adult↗
PubMed2004

Surgical management of cloacal malformations: a review of 339 patients.

BACKGROUND/PURPOSE: The aim of this study was to describe lessons learned from the authors' series of patients with cloaca and convey the improved understanding and surgical treatment of the condition's wide spectrum of complexity. METHODS: The medical records of 339 patients with cloaca operated on by the authors were retrospectively reviewed. RESULTS: A total of 265 patients underwent primary operations, and 74 were secondary. All patients were approached posterior sagittally; 111 of them also required a laparotomy. The average length of the common channel was 4.7 cm for patients that required a laparotomy and 2.3 cm for those that did not. Vaginal reconstruction involved a vaginal pull-through in 196 patients, a vaginal flap in 38, vaginal switch in 30, and vaginal replacement in 75 (36 with rectum, 31 with ileum, and 8 with colon). One hundred twenty-two patients underwent a total urogenital mobilization. Complications included vaginal stricture or atresia in 17, urethral strictures in 6, and urethro-vaginal fistula in 19, all of which occurred before the introduction of the total urogenital mobilization. A total of 54% of all evaluated patients were continent of urine and 24% remain dry with intermittent catheterization through their native urethra and 22% through a Mitrofanoff-type of conduit. Seventy-eight percent of the patients with a common channel longer than 3 cm require intermittent catheterization compared with 28% when their common channel was shorter than 3 cm. Sixty percent of all cases have voluntary bowel movements (28% of them never soiled, and 72% soiled occasionally). Forty percent are fecally incontinent but remain clean when subjected to a bowel management program. Forty-eight patients born at other institutions with hydrocolpos were not treated correctly during the neonatal period. The surgeons failed to drain the dilated vaginas, which interfered with the drainage of the ureters and provoked urinary tract infections, pyocolpos, and/or vaginal perforation. In 24 patients, the colostomy was created too distally, and it interfered with the pull-through. Twenty-three patients suffered from colostomy prolapse. All of these patients required a colostomy, revision before the main repair. Thirty-six patients underwent reoperation because they had a persistent urogenital sinus after an operation done at another institution, and 38 patients underwent reoperation because they suffered from atresia or stenosis of the vagina or urethra. The series was divided into 2 distinct groups of patients: group A were those with a common channel shorter than 3 cm (62%) and group B had a common channel longer than 3 cm (38%). CONCLUSIONS: The separation of these groups has important therapeutic and prognostic implications. Group A patients can be repaired posterior sagittally with a reproducible, relatively short operation. Because they represent the majority of patients, we believe that most well-trained pediatric surgeons can repair these type of malformations, and the prognosis is good. Group B patients (those with a common channel longer than 3 cm), usually require a laparotomy and have a much higher incidence of associated urologic problems. The surgeons who repair these malformations require special training in urology, and the operations are prolonged, technically demanding, and the functional results are not as good as in group A. It is extremely important to establish an accurate neonatal diagnosis, drain the hydrocolpos when present, and create an adequate, totally diverting colostomy, leaving enough distal colon available for the pull-through and fixing the colon to avoid prolapse. A correct diagnosis will allow the surgeon to repair the entire defect and avoid a persistent urogenital sinus. Cloacas comprise a spectrum of defects requiring a complex array of surgical decisions. The length of the common channel is an important determinant of the potential for urinary control, and predicts the extent of surgical repair.

Cloaca↗
PubMed2004

Cloacal exstrophy: morbidity associated with abnormalities of the gastrointestinal tract and spine.

BACKGROUND/PURPOSE: The aim of this study was to review the management of the gastrointestinal tract in cloacal exstrophy and to assess the effect of spinal dysraphism on nutritional outcome. METHODS: Twenty-two patients with cloacal exstrophy were reviewed retrospectively. Gastrointestinal and spinal anomalies were documented. The need for nutritional supplementation was recorded. Weights at 1 and 5 years of age were used to assess growth in childhood. RESULTS: Ten patients were treated initially with ileostomy, 7 with colostomy, and 3 without stoma. Two patients died before surgical reconstruction. Total parenteral nutrition (TPN) was utilized in 8 infants for a median of 10 days (range, 5 to 200). Three patients had complications with colostomies requiring conversion to ileostomy. Patients with an ileostomy required more nutritional supplementation compared with patients with a colostomy (50% v 28%). High-output stoma losses were more common in patients with an ileostomy (40% v 14%). Fourteen patients (67%) with spinal dysraphism had a higher incidence of failure to thrive in the first year of life (69% v 26%) and multiple episodes of enteritis (40% v 25%). Two neonates with duodenal atresia and small bowel deletion died within the first month of life. One patient with short bowel syndrome died of TPN-associated liver disease at 6 months of age. There were no other deaths. CONCLUSIONS: The gastrointestinal tract contributes significantly to the morbidity and mortality in cloacal exstrophy. Nutritional supplementation is more frequently required in patients with an ileostomy. Stoma complications were higher in those with a colostomy. Morbidity is high in patients with spinal dysraphism.

Abnormalities, Multiple↗
PubMed1982

Primary corrective operation without decompression in infants less thn three months of age with Hirschsprung's disease.

From Jan 1, 1965 to Nov 1, 1980, 155 infants with Hirschsprung's disease have been treated. All had confirmed aganglionosis at multiple rectal biopsies. From 1965 to 1969, 54 patients underwent a Swenson's procedure at an age ranging from 12 to 18 months after a preliminary colostomy. 13 patients died between colostomy and definitive operation. From 1969 to 1977, the delay in performing corrective operation after colostomy was shortened and the definitive procedure was done between 6 and 11 months of age in 69 patients. No fatality was observed but in 9 cases a perianal dermatitis lowered the quality of functional results. From 1977 to Nov 1, 1980, progress in immediate nursing and total parenteral nutrition made colostomy unnecessary in 19 neonates and infants with severe Hirschsprung's disease. The definitive surgical procedure (mainly Swenson's) was performed before 3 months of age. The postoperative results were excellent. After more than 4 years of follow-up for the first cases, the good secondary results, the quality o defecation, and the shortening of total hospital time, allow us to advocate this method in selected cases.

Colostomy↗
PubMed1999

Surgical repair of rectovestibular fistula with normal anus.

PURPOSE: The aim of this study was to evaluate the authors' surgical approach and technique in patients with congenital rectovestibular fistula with a normal anus (CRF). METHODS: During the period between 1981 and 1995, 19 girls from 2 months to 13 years of age were treated surgically for CRF by a primary perineal approach. After appropriate bowel preparation, the patient was placed in a lithotomy position. A probing catheter was placed in the fistula. A perineal transverse skin incision was made on the midpoint between the posterior commissure and the anus, and the underlying tissue was dissected. The fistula was divided, and the both ends were closed by interrupted sutures. The external sphincter muscle was mobilized to interpose between the vestibular and rectal stumps of the fistula. Postoperative feeding was begun on day 6. RESULTS: A protecting colostomy was created in the early 4 patients. Fifteen patients underwent a primary fistula division without colostomy. In those without colostomy, 1 patient had a reopening of the fistula 6 days after the primary repair. In this patient, colostomy was created, and the fistula was divided 6 months later by the same approach. After a follow-up of 3 to 17 years, all patients have normal bowel habit. CONCLUSION: A primary perineal approach is appropriate for the treatment of CRF.

Adolescent↗
PubMed1989

Management of rectal injuries during radical cystectomy.

We reviewed the incidence and management of intraoperative rectal injuries in patients who underwent radical cystectomy from January 1980 through July 1988 to assess the role of primary repair without diverting colostomy as definitive therapy. During this interval 163 radical cystectomies were performed and 125 charts were available for review. The incidence of rectal injuries was 9.6% (12 of 125 patients). The rate of rectal injury in patients who had previously received definitive pelvic radiation was 27% (3 of 11). The incidence of injury in patients who received 2,000 rad preoperative radiation (11%, 2 of 17) was similar to that noted in individuals who were not irradiated (7%, 7 of 97). Of the 12 patients with rectal injury 9 underwent primary closure without diverting colostomy. The remainder were treated with an initial colostomy. Only 1 patient who had not received prior radiation required a colostomy after initial treatment with primary closure. The 8 successful primary rectal closures were done in 2 patients who underwent definitive pelvic radiation, 2 who had received 2,000 rad preoperatively and 4 who had not been irradiated.

Aged↗
PubMed1998

Sphincter preservation in rectal cancer. External-beam radiation therapy alone.

Surgery with or without adjuvant radiation therapy and chemotherapy is the standard treatment for patients with resectable rectal carcinoma. Many patients, however, are medically unfit or simply refuse surgery that could result in a colostomy. This article reviews the results of external-beam radiation therapy alone for selected patients with rectal carcinoma and its role in preserving anorectal function. For patients with mobile tumors, a 5-year survival and local relapse-free rate of 30% and 25%, respectively, can be expected after external-beam radiation therapy alone, and 60% remain colostomy free. Results of radiation therapy alone in patients with fixed or unresectable tumors are poor. Although more than a third of patients remain colostomy-free, only 5% of patients survive 5 years. In patients with mobile rectal carcinomas that are not amenable to sphincter-preserving surgery, who are unfit medically for radical surgery, or who refuse a colostomy, external-beam radiation therapy offers the reality of sphincter preservation and the possibility of long-term tumor control.

Anal Canal↗
PubMed2001

Hirschsprung's disease in the newborn: experience in Zaria, Nigeria.

In a 10-year retrospective review of 15 newborns aged < or = 42 days presenting with Hirschsprung's disease, there were 12 boys and three girls aged 4-42 days (median 18 days). Twelve babies presented with complete intestinal obstruction. In 12 babies, there was a history of delayed passage of meconium (after 2-6 days). One baby each developed caecal and sigmoid perforation. Barium enemas in three babies without complete intestinal obstruction suggested Hirschsprung's disease in two. Following resuscitation, the two infants who had perforated had caecostomy and sigmoid repair with right transverse colostomy, respectively. One infant had ileostomy for total colonic aganglionosis associated with ileal atresia. All the others had initial diversion colostomy. Rectal biopsies confirmed Hirschsprung's disease in all the babies. The ileum was injured during colostomy in one case, requiring repair. Postoperative anastomotic leakage occurred in the infant with ileal injury and colostomy necrosis occurred in another infant. Five babies (33%) died, three from overwhelming infection (caecal perforation, sigmoid perforation, ileal injury), one from hypokalaemia (ileostomy) and one from an unidentified cause. Few cases of Hirschsprung's disease present in the newborn period in our environment and, when they do, they usually present with complete intestinal obstruction with high morbidity and mortality.

Biopsy↗
PubMed2002

Improving outcomes following penetrating colon wounds: application of a clinical pathway.

INTRODUCTION: During World War II, failure to treat penetrating colon injuries with diversion could result in court martial. Based on this wartime experience, colostomy for civilian colon wounds became the standard of care for the next 4 decades. Previous work from our institution demonstrated that primary repair was the optimal management for nondestructive colon wounds. Optimal management of destructive wounds requiring resection remains controversial. To address this issue, we performed a study that demonstrated risk factors (pre or intraoperative transfusion requirement of more than 6 units of packed red blood cells, significant comorbid diseases) that were associated with a suture line failure rate of 14%, and of whom 33% died. Based on these outcomes, a clinical pathway for management of destructive colon wounds was developed. The results of the implementation of this pathway are the focus of this report. METHODS: Patients with penetrating colon injury were identified from the registry of a level I trauma center over a 5-year period. Records were reviewed for demographics, injury characteristics, and outcome. Patients with nondestructive injuries underwent primary repair. Patients with destructive wounds but no comorbidities or large transfusion requirement underwent resection and anastomosis, while patients with destructive wounds and significant medical illness or transfusion requirements of more than 6 units/blood received end colostomy. The current patients (CP) were compared to the previous study (PS) to determine the impact of the clinical pathway. Outcomes examined included colon related mortality and morbidity (suture line leak and abscess). RESULTS: Over a 5.5-year period, 231 patients had penetrating colon wounds. 209 survived more 24 hours and comprise the study population. Primary repair was performed on 153 (73%) patients, and 56 patients had destructive injuries (27%). Of these, 40 (71%) had resection and anastomosis and 16 (29%) had diversion. More destructive injuries were managed in the CP group (27% vs. 19%). Abscess rate was lower in the CP group (27% vs. 37%), as was suture line leak rate (7% vs. 14%). Colon related mortality in the CP group was 5% as compared with 12% in the PS group. CONCLUSIONS: The clinical pathway for destructive colon wound management has improved outcomes as measured by anastomotic leak rates and colon related mortality. The data demonstrated the need for colostomy in the face of shock and comorbidities. Institution of this pathway results in colostomy for only 7% of all colon wounds.

Abdominal Abscess↗
PubMed1984

Penetrating colon trauma.

Of 56 patients with penetrating colon injuries over 6 years, 15% underwent exteriorized repair, 21% received a colostomy, and 64% were treated with primary repair. Of the eight exteriorized repairs, four required conversion to colostomies. In the entire group of 12 colostomies, there were two deaths, four abscesses, and one empyema. Thirty-six patients (64%) underwent primary repair. In this group there was one superficial wound infection, one empyema, but no intra-abdominal abscesses. Eighty per cent had associated injuries. All laparotomy incisions in the primary repair group except two were closed primarily. Large amounts of saline irrigant were used in all cases. All patients received broad spectrum antibiotics pre- and postoperatively. Primary repair of colon injuries can be done safely in many cases. Proper attention must be given to the associated injuries, the patient's general condition, and the time interval between injury and repair. We now find few indications for exteriorization of injured colons. Colostomies are done if our criteria for safe primary repair are not fulfilled.

Adolescent↗
PubMed1989

Penetrating injuries to the colon: analysis by anatomic region of injury.

The preferred method for the treatment of penetrating injuries to the colon remains a source of controversy. In our retrospective review of 65 patients with penetrating colon injuries, 33 patients were managed by colostomy formation, 30 were treated by primary repair, and two had exteriorized repair with early return to the abdominal cavity (drop back). The anatomic location of injury was ascending colon in 19 (29%), transverse colon in 20 (31%), descending colon in 22 (34%), and multiple sites in four (6%). The average penetrating abdominal trauma index (PATI) was 24 (ascending colon injuries, 23; transverse colon, 26; descending colon, 24; and multiple colon sites, 28). Overall septic morbidity was 15/65 (23%). Colostomy closure was later done in 32/33 (97%), with a morbidity of 7/32 (22%). The mean length of hospital stay for primary repair was ten days and for colostomy (including both required hospital stays), 26 days (P less than .05). These data suggest that primary repair is as safe as colostomy formation for the management of penetrating colon injuries, regardless of anatomic site of injury.

Adult↗