PRIMARY REPAIR OF PENETRATING COLONIC INJURIES

Abstract

Treatment modalities of penetrating colonic injuries, that present with high morbidity and mortality are still debatable. The aim of this study is, to clarify the choice between primary repair and colostomy. 45 patients that were treated in our Surgical Emergency Unit during the last 3 years have been retrospectively analyzed. The wound site was on the left colon in 32 cases and on the right colon in 13 cases. 34 of the patients had stabbing and 11 gunshot wounds. Treatment modalities were evaluated according to the penetrating abdominal trauma index (PATI). Operative procedures performed on the left colon were: primary suture in 13 cases, loop colostomy in 8 cases, Devine colostomy in 7 cases, resection and Hartmann's procedure in 3 cases and primary suture and cecostomy in 1 case. In this group, abscess in 3 cases, sepsis in 4 cases and suture insufficiency in 2 cases were found, and 5 of these patients were dead. Operative procedures performed on the right colon were: primary repair in 9 cases and primary suture+cecostomy in 2 cases. In a patient with a primary repair and cecostomy an intestinal fistula was noted and no deaths were recorded. These results display that for the treatment of right colon injuries primary repair is a safe method that has to be supported by a complementary cecostomy. In the treatment of left colon injuries with a low trauma and colon score primary suture and exteriorization, and in injuries with a high trauma and colon score primary repair + exeriorization should be preferred to loop colostomy.