Destructive colon injuries associated with severe pancreatic injuries: Primary anastomosis or ostomy

Primary anastomosis (PA) is preferred over ostomy creation in most trauma patients with colon injuries. However, concomitant pancreatic injury is considered as a risk factor for anastomotic breakdown. This study investigates outcomes of PA versus ostomy in patients with associated severe pancreatic injuries.

This ACS TQIP study included patients with severe colon injuries requiring resection and associated severe pancreatic injuries (AIS ≥3). Patients were categorized into anastomosis or ostomy groups. Anastomosis patients were propensity score-matched (1:2) to ostomy patients, controlling for age, gender, ISS, and pancreatic AIS. The primary outcome was surgical site infection (SSI), and secondary outcomes included unplanned return to the operating room (OR), length of stay (LOS), and ICU LOS.

Of 269 patients, 60 underwent anastomosis and 209 received an ostomy. Sixty anastomosis patients were matched to 120 ostomy patients. Median ISS, rates of severe head, chest, abdominal, renal, and small bowel injuries, hypotension on admission, transfusion requirements, and comorbidities were similar. SSI rates (10.0% vs 17.5%, p = 0.184) and unplanned return to OR (8.3% vs 14.2%, p = 0.260) did not differ between cohorts. However, the ostomy group had significantly longer median LOS (21 vs 31 days, p = 0.005) and ICU LOS (10 vs 14 days, p = 0.033).

In patients with severe pancreatic injuries undergoing colon resection, PA was not associated with increased SSIs or unplanned return to the OR compared to ostomy creation. Primary anastomosis was also associated with shorter hospital and ICU stays. These findings support the safety of PA, guided by clinical judgment.