Penetrating injuries to the colon

In planning the management of a colonic injury, several factors must be taken into account, including the age of the patient, the cause of the wound, the time lapse from injury to operation, area and the type of wound, the amount of fecal soilage, and the number and extent of associated injuries. For extensive wounds with associated injuries, fecal contamination of the abdomen, or delay from injury to treatment, a two-stage procedure is preferred. Primary closure or primary resection is the preferred treatment for right colon injuries, depending on the severity of the injury. Resection and anastomosis should not be performed in the left colon without a diverting colostomy. Exteriorization is a satisfactory procedure for major colon injury; however, exteriorization and repair have a higher associated complication rate than exteriorization alone. Primary repair is a safe and acceptable procedure, irrespective of the site of injury. Indications for primary repair may, in the future, be expanded to include those wounds presently being treated by exteriorization.