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The morbidity of penetrating colon injury
Eileen M Bulger1, Kerry McMahon, Gregory J Jurkovich
1Department of Surgery, Harborview Medical Center, University of Washington, Box 359796, 325 Ninth Avenue, Seattle, WA 98104, USA. ebulger@u.washington.edu
Unlabelled:
The purpose of this study is to define the current morbidity and mortality associated with penetrating colon injury and to determine the impact of management strategy on outcome.
Methods:
A retrospective review was performed of all penetrating colon injuries managed at a level I trauma center (1990-2000), n=186. Stepwise logistic regression was used to determine the independent predictors for colostomy and morbidity following colon injury.
Results:
Fifty-three percent of the patients were managed with primary repair or anastomosis while 47% received a colostomy. Independent predictors of colostomy included gunshot wound (GSW), degree of peritoneal contamination, and location of injury. The complication rate for patients requiring a colostomy was 57% versus 42% for the primary repair group, P=0.01. When adjusted for injury severity and hypotension, the presence of a colostomy was not associated with a significant increase in the complication rate (OR 1.7, 95% CI: 0.9-3.25). Independent predictors for the development of intra-abdominal abscess were hypotension on admission (OR 2.4, 95% CI: 1.1-5.8) and penetrating abdominal trauma index (PATI) score >25 (OR 4.2, 95% CI: 2.0-8.9). The complication rate for colostomy takedown was 17%.
Conclusion:
Penetrating colon injury carries a high rate of infectious morbidity. The development of infectious complications is related to the injury severity and haemodynamic status of the patient, not the type of operation performed.