Primary repair of colon injuries

Colonic injuries are usually treated by exteriorization, resection and colostomy, or primary repair with proximal colostomy. However, many cases of successful treatment of colonic wounds by primary suture without colostomy have been reported. Yet, these repairs are usually restricted to civilian injuries, stab wounds, perforations of the right colon, cases with few or no other organ injuries, a short time interval between injury and operation, absence of shock, and minimal fecal soiling. We considered lack of fecal spillage to be the only important factor for 12 consecutive patients, the majority war casualties, and performed primary colon repairs on them. All the other commonly accepted limiting factors were disregarded. There were no complications related to the bowel repair. Using these more liberal guidelines, the number of primary repairs of colonic injuries may be increased, thus reducing hospitalization time and cost, and more important, reducing morbidity and mortality associated with the creation and subsequent closure of colostomies.