Primary repairing in penetrating colon injuries

The large bowel is injured in about 10% of penetrated abdominal injuries. Primary repair with colostomy has been discussed recently.

Between 1987 and 1995, sixty-five patients were operated on with penetrated colon injuries were treated with primary repair without colostomy. Any patient with one or more of the following criteria was excluded: Age > 60 years, blood pressure < 80/60 mmHg, time from injury to treatment > 8 hours, Penetrating abdominal trauma index > 50.

The mean age of the patients was 31 and female/male ratio was 1/7. Fifty-one patients (78.5%) were exposed to colon injury by stabbing and 14 patients (21.5%) by gunshot. The most frequently injured segment was the transverse colon (36.9%). The liver was the most commonly injured organ associated with colon injury (32.3%). Colon wounds of 48 patients (73.8%) were treated with simple repair consisting of meticulous debridement. All gunshot wounds (14 patients) and 3 of the stab wounds were treated with segmentary resection and two layered anastomosis because of the massive colonic wall injury and/or impairment of the blood supply. The most common postoperative complication was wound infection (12.3%). Intraabdominal infection and leakage of the anastomosis were not observed.

Primary repair or, if necessary, segmentary resection and anastomosis will be more appropriate in civilian colon injuries.