Colostomy in penetrating colon injury: is it necessary?

To compare in a randomized prospective manner the complication rates associated with colostomy versus primary repair in penetrating colon injuries.

During a 38-month period, 114 patients with penetrating wounds of the colon were entered into a randomized prospective study at an urban Level I trauma center. The patients were randomized to a primary repair group or a diversion group. Randomization was completely independent of any risk factors, including number of abdominal organ systems injured, extent of fecal contamination, blood loss, presence of shock (systolic blood pressure < 80), time from injury to operation, and severity of colon injury. Five patients initially entered in the study died in the immediate postoperative period (< 24 hours) and were removed from the study because their deaths were unrelated to their colon injuries.

A total of 109 patients were studied, of which 56 were randomized to primary repair and 53 to diversion (39 colostomies, 14 ileostomies). The average age for the primary repair group was 28.5 years and for the diversion group it was 26.8 years. The average Penetrating Abdominal Trauma Index for the primary repair group was 24.3 and for the diversion group it was 22.8. There were 11 (20%) septic-related complications in the primary group versus 13 (25%) in the diversion group. Complication rates in the presence of significant fecal contamination, shock, significant blood loss (> 1000 mL), more than two organ systems injured and extent of colon injury were all higher in the diversion group. There was one mortality in the diversion group and two in the primary repair group.

The authors conclude that all penetrating colon injuries in the civilian population should be primarily repaired.