Primary repair of colon injuries: a retrospective analysis

Primary repair, or resection and anastomosis, should be considered for treatment of all civilian patients with penetrating colon injuries. During the past six years, 154 patients with colon injuries (excluding rectal injuries) were treated in an urban trauma center. Primary repair, including resection and anastomosis, was performed in 102 patients (66%) and diversion in 52 patients (34%). Injuries were graded according to the Penetrating Abdominal Trauma Index (PATI) and Colon Organ Injury Scale (CIS). The average PATI score for the primary repair group was 22.1; the diversion group was 25.3. The majority of injuries as graded by CIS for the primary repair group were grades 2 (27%) and 3 (38%); the diversion group grades were 3 (31%) and 4 (46%). There was no significant difference between the two groups. There were 11 septic-related complications in the diversion group and 10 septic-related complications in the primary repair group. Independent risk factors for adverse outcomes were compared in each group and used to calculate the probability for adverse outcomes. The probability for adverse outcome was significantly greater in the diversion group. Associated risk factors were not useful in predicting an increase in morbidity and mortality in either group. However, PATI had greater predictive value for determining morbidity and mortality than did CIS. Primary repair or resection and anastomosis should be considered for treatment of all penetrating colon injuries excluding rectal injuries.