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Iatrogenic and accidental colon injuries--what to do?
S R Thomson1, M Fraser, C Stupp
1Department of Surgery, University of Natal Medical School, Durban, South Africa.
Purpose:
This study was designed to formulate management guidelines for a variety of rare iatrogenic and accidental injuries to the colon and rectum.
Methods:
This review collates the available evidence in the literature.
Results:
Both investigative and therapeutic maneuvers involving the colon, particularly endoscopy and radiographic contrast studies, are the most common cause of significant injury although the incidence is low. Even less common are injuries produced, at open surgery and minimally invasive surgery, by foreign bodies, enemas, or compressed air. The mechanisms and management of these injuries are discussed in detail.
Conclusions:
Evidence exists to support that a nonoperative approach is safe for the majority of injuries, particularly when the colon is "clean" at the time of injury. Adequate resuscitation, observation, and repeated reassessment are mainstays of a conservative policy. Operation is essential for progression of abdominal signs. Patients with established peritonitis at the time of presentation or with an unprepared bowel are best served by prompt operation.