Injuries of the retroperitoneal portions of the colon and rectum

Experience with 66 penetrating injuries of the retroperitoneal colon and rectum is reviewed. These injuries usually affect the intraperitoneal anterior and the retroperitoneal posterior walls. The bare areas of the colon have to be inspected when only one intraperitoneal hole is found or whenever the wound is in the flank or back. There is an increasing tendency toward primary suture rather than exteriorization unless there are multiple severe intra-abdominal injuries, gross contamination, or poor general condition of the patient. Rectal injuries require careful repair, diverting colostomy, irrigation of the excluded rectum and presacral drainage. For suspected bowel injuries, antibiotics should be started preoperatively.