[Trauma to the colon in civilian surgery]

There is nowadays no current randomised study able to answer if a diverting colostomy is necessary or not in the surgical management of civilian colon trauma. We report our experience on 13 cases treated during the period from 1977 to 1997. There were 3 stab wounds, 4 gunshot traumas and 6 perforations of the colon caused by blunt mechanisms. Four patients underwent a primary colonic closure and 9 others a primary resection with anastomosis. In none of all our cases a diverting colostomy was performed. We experienced a fatal complication once and this was due to an underestimated segmental ischemia of the colon after blunt injury. Reviewing the late publications together with our modest experience we are allowed to conclude that primary repair without a stoma is the treatment of choice when the tissues show a good vascularisation. This often is the case with stab wounds and low velocity gunshot traumas. We would prefer a diverting colostomy in cases of blunt trauma of high energy and while haemodynamic instability makes the estimation of adequate tissue vascularisation difficult. Colonic lesions due to high velocity bullets should be managed as if they where wounds of war.