Factors affecting the outcome of exteriorized colon repairs

Of 32 penetrating colon injuries managed by repair and exteriorization during the past 5 years in 16 (50%) of the exteriorized repairs healed and 16 failed, being converted to colostomies. The overall morbidity was 25%, 19% for the healed anastomoses and 31% for those that failed. The two groups were similar with respect to age, location of injury, presence of shock, presence of associated injuries, and degree of fecal contamination. Significant differences were evident in the mechanism of trauma and the severity of tissue damage. Exteriorization of colon suture lines is a viable alternative in the management of penetrating colon injury. It should be employed primarily in cases where factors other than the tissue injury itself prohibit primary repair. The success of exteriorization can be improved by giving attention to technical details: adequate debridement; wide mobilization; keeping the repair moist; delaying return of the colon until the tenth postoperative day.