Colonic trauma: indications for diversion vs. repair

The management of colonic trauma has evolved considerably over the past several decades. An appreciation of best-evidence practices is paramount to the optimal management of these injuries.

Literature review of pertinent clinical literature regarding the management of colonic trauma was performed.

Based on available level I evidence, primary repair of all colorectal injuries should be attempted, irrespective of associated risk factors. Diversion should only be considered if the colonic tissue itself is deemed inappropriate for repair, as in the setting of prohibitive edema or questionable perfusion of the tissues. Diversion does remain the standard of care for the management of extra-peritoneal rectal injuries, although this practice is under active investigation.

Level 1 evidence has failed to demonstrate that routine proximal diversion, once considered the standard of care for the treatment of all colorectal trauma, affords benefit for victims of the injuries. While utilization of these practices may prove beneficial in select circumstances, the routine utilization of proximal diversion for the treatment of colorectal injuries is unwarranted.