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Blunt colonic injury--a multicenter review
S E Ross1, R A Cobean, D B Hoyt
1Department of Surgery, Cooper Hospital/University Medical Center, Camden, New Jersey.
The Journal of Trauma
|September 11, 1992
Summary
Primary repair of blunt colon injuries is safe and effective without a diverting colostomy, except in cases of gross fecal contamination. This approach is suitable for blunt trauma patients requiring laparotomy.
Area of Science:
- Trauma Surgery
- Colorectal Surgery
- Surgical Management
Background:
- Management of colon injuries has shifted towards primary repair without diverting colostomy.
- Limited data exists for blunt colon injuries compared to penetrating trauma.
- Uncertainty remains regarding applying penetrating injury principles to blunt colon trauma.
Purpose of the Study:
- To evaluate the safety and efficacy of primary repair for blunt colon injuries.
- To determine the incidence of colonic injury in blunt trauma patients undergoing laparotomy.
- To identify contraindications and factors influencing outcomes in blunt colon injury management.
Main Methods:
- Retrospective review of 54,361 major blunt trauma patients from 1986-1990.
- Analysis of data from 286 patients with colonic injuries.
- Statistical analysis to assess morbidity associated with surgical management.
Main Results:
- Colonic injury occurs in over 10% of blunt trauma patients needing laparotomy.
- Diagnostic tools are unreliable for isolated colonic pathology.
- Primary repair or resection/anastomosis is safe without diversion, barring gross fecal contamination.
- Delayed surgery, shock, and antibiotic timing did not significantly increase morbidity.
Conclusions:
- Primary repair of blunt colon injuries is a viable option without diversion.
- Gross fecal contamination is the primary contraindication for primary repair.
- This management strategy can be safely applied to blunt colon trauma patients.