Colorectal trauma

Colorectal injury remains a source of significant morbidity and mortality. Gunshot and stab wounds are the most common etiologic agents. Diagnosis is usually established on clinical grounds. For the purposes of management, the large bowel can be considered as colon and rectum. Minor colon injuries can be repaired primarily; management of major colon injuries or injuries associated with multiple organ involvement, significant blood loss, or massive contamination should be individualized. Diversion or exteriorization remains the gold standard of treatment when there is any doubt. Rectal injury should be repaired when feasible and diverted and the presacral space drained. Distal rectal washout is of proven merit. Antibiotics provide an important adjunct to therapy. They should be initiated early (preoperatively), ended quickly (12 to 72 hours postoperatively), and provide a broad spectrum of coverage. The treatment of established infection should be guided by bacterial culture. Postoperatively, aggressive support is important for a good outcome. The significant incidence of complications even in the face of optimal management demands continued vigilance and aggressive intervention by the operating surgeon.