Trauma of the colon: early drop-back of exteriorized repair

Exteriorized repair of selected colonic injuries has been reported to be successful. Eighty-two colonic injuries were reviewed to determine the indications for primary repair, exteriorized repair, or colostomy and to assess the feasibility of early drop-back of the exteriorized repaired colon. Injuries were graded into three stages: stage 1, good risk; stage 2, moderate risk; and stage 3, bad risk. Sixty-seven percent of patients with stage 1 injuries underwent primary repair, 61% of patients with stage 2 injuries underwent exteriorized repair, and 61% of patients with stage 3 injuries received a colostomy. Of 38 patients who had exteriorized repair, 29 (76%) had their colon successfully dropped back on an average of five days postoperatively. Nine patients had their exteriorized colon converted to a colostomy on an average of 5.5 days postoperatively. The overall mortality was 2.4%; however, the mortality of the patients with exteriorized repair was 0%. Exteriorized repair with early drop-back is safe and economical for most patients with stage 2 injuries and selected patients with stage 3 injuries.