Bowel injury

Small bowel and colon injury represents a significant portion of injuries sustained during penetrating trauma. These wounds may be tangential or through and through. Low velocity wounds are expected in the civilian setting, but high velocity wounds or shotgun injuries at close range can be seen as well. Most often these patients are explored and the injuries sustained can be managed effectively. Selective non-operative management for penetrating abdominal trauma is indicated only when there is no evidence of on-going hemorrhage or hollow viscus injury. The decision to abandon non-operative care must be made very early during the initial hospital course. In contrast bowel injury in blunt abdominal trauma may be difficult to detect. The clinical assessment and initial imaging will often define the extent of injury. However, patients with associated distracting injuries or subtle clinical signs will provide a greater challenge. This paper reviews the overall approach to patients with small bowel and colorectal trauma. It highlights published literature and makes recommendations regarding care based on injury assessment and the patients overall clinical condition. As surgeons we must use an evidenced based approach to undergird our clinical decision making. By doing so, we hope to bring improved outcomes and safer care to our patients.