PRIMARY REPAIR OR COLOSTOMY IN THE MANAGEMENT OF BLUNT AND PENETRATING COLONIC INJURIES

Abstract

The surgical management of colon injuries requires individualization. Primary repair, either by debritment and suture or resection and anastomosis is a safe method of management in selected cases and results in a shorter hospital stay, less morbidity, a complication rate that is no higher, in this series thirty-nine patients who had sustained blunt or penetrating colon injuries were retrospectively analyzed over a period of 5 years. The methods of colon wounds management and complications were reviewed. Thirty-eight percent of patients were managed by intraperitoneal primary repair and sixty-two percent by colostomy or exteriorization of the injury. Patients treated by primary repair of the colon had less colon related complications and shorter hospital stay than those treated by colostomy (mean 13 versus 27 days respectively). Left and right colon injuries treated by a primary repair had similar complications rate and hospital stay.

We believe that primary repair can safely be performed at both sides of the colon, but colostomy still has a very important place in the management of both right and left colon injuries with gross peritoneal contamination, extensive colonic damage and presence of associated organ injuries.