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The injured colon.

J M Burch, J C Brock, L Gevirtzman

    Annals of Surgery
    |June 1, 1986
    PubMed
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    Primary repair of civilian colon injuries is safe and effective, showing lower mortality and fewer abscesses than colostomy. This approach should be the standard treatment for colon injuries.

    Area of Science:

    • Trauma Surgery
    • Surgical Management of Colon Injuries

    Background:

    • Civilian colon injuries present management challenges, with ongoing debate on colostomy versus primary repair.
    • The role of exteriorized repair in managing colon injuries is also a point of discussion.

    Purpose of the Study:

    • To evaluate the safety and outcomes of primary repair, colostomy, and exteriorized repair for civilian colon injuries.
    • To identify factors influencing the choice of surgical management and their impact on patient outcomes.

    Main Methods:

    • Retrospective analysis of 727 patients with colon injuries treated at an urban trauma center from 1979-1984.
    • Categorization of treatment into primary repair, colostomy, and exteriorized repair.
    • Statistical analysis to compare mortality, morbidity, and abscess rates between treatment groups and identify influencing factors.

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    Main Results:

    • Primary repair was associated with significantly lower mortality (p<0.01) and fewer abdominal abscesses (p<0.01) compared to colostomy.
    • Shock and age over 40 were significant predictors of mortality (p<0.01).
    • Exteriorized repair successfully avoided colostomy in 59% of cases.

    Conclusions:

    • Primary repair of civilian colon injuries offers minimal morbidity and mortality and should be the primary treatment strategy.
    • Colostomy is associated with higher complication rates and should not be the default management.
    • Factors like injury extent, shock, and patient age influence management decisions and outcomes.