Management of colon injuries

The evaluation and management of colon injuries have recently undergone significant changes. The time-honored philosophy of conservative management by repair and diversion is giving way to a more aggressive approach, which includes primary repair of many injuries. The role of colostomy has been challenged by the need for additional operative procedures, patient disability, and rising hospital and medical costs. Based on the current literature, the authors have come to the following conclusions: 1. Primary repair is safe in carefully selected cases. 2. Colostomy should not be abandoned because of a fear of the morbidity associated with its closure. 3. The difference between injuries on the right and the left is questionable and probably not as significant as previously thought. 4. Exteriorized repair frequently requires conversion to colostomy and probably has little indication for use. 5. Short-term perioperative single-antibiotic coverage is sufficient. 6. Use of drains cannot be supported in most instances. 7. Wounds are best left open in patients with significant contamination. Surgical judgment remains the final arbiter in the decision process. These controversies and the debate generated have sharpened the guidelines for that judgment.