BACKGROUND
Colon injury has been associated with a high risk of septic complications and mortality. We prospectively studied the pattern, management, outcome, and prognostic factors in patients who sustained penetrating colon injuries.
PATIENTS AND METHODS
Sixty patients who presented to our hospital with penetrating colon injuries over a ten-year period (1992 to 2001) were studied.
RESULTS
Colon wounds were caused by gunshots in 55 (91.7 percent) patients and knife stabs in 5 (8.3 percent). There was a delay of more than 12 hours before laparotomy in 30 (50 percent) patients. Moderate or major fecal contamination of the peritoneal cavity occurred in 58 (96.7 percent) patients. The average penetrating abdominal trauma index score was 25.9 and 20 (33.3 percent) patients sustained Flint Grade 3 colon injury. Associated intra-abdominal injuries occurred in the small bowel (73.3 percent), liver (25 percent), stomach (23.3 percent), and mesentery (16.7 percent). Right colon wounds (35) were managed by primary repair in 24 (68.6 percent) patients and proximal diverting colostomy in 11 (31.4 percent), whereas left colon wounds (25) were managed by diverting colostomy in 22 (88.0 percent) patients and primary repair in 3 (12.0 percent) patients. Common complications included wound infection (56.7 percent), septicemia (31.7 percent), and enterocutaneous fistula (16.7 percent). The overall mortality rate was 33.3 percent and colon injury–related mortality was 21.7 percent. Presence of destructive colon injury was associated with a greater than fourfold increased incidence of death. Other significant risk factors included shock on admission, major fecal contamination, duration of operation more than four hours, penetrating abdominal trauma index score >25, and more than two postoperative complications. There was no difference in outcome between patients who had primary repair and those undergoing diverting colostomy. Colostomy closure–related morbidity was 21 percent and mortality was 5.3 percent.
CONCLUSION
A more liberal use of primary repair is required in our patients with penetrating injuries of the colon.
Similar content being viewed by others
REFERENCES
TJ Curran AP Borzotta (1999) ArticleTitleComplications of primary repair of colon injury: literature review of 2,964 cases Am J Surg 177 42–7 Occurrence Handle10.1016/S0002-9610(98)00293-1 Occurrence Handle1:STN:280:DyaK1M7lsV2isw%3D%3D Occurrence Handle10037307
RP Gonzalez GJ Merlotti MR Holevar (1996) ArticleTitleColostomy in penetrating colon injury: is it necessary? J Trauma 41 271–5 Occurrence Handle8760535 Occurrence Handle1:STN:280:BymA3s3js1Q%3D
RP Gonzalez ME Falimirski MR Holevar (2000) ArticleTitleFurther evaluation of colostomy in penetrating colon injury Am Surg 66 342–6 Occurrence Handle1:STN:280:DC%2BD3c3js1Khug%3D%3D Occurrence Handle10776870
D Demetriades JA Murray L Chan et al. (2001) ArticleTitlePenetrating colon injuries requiring resection: diversion or primary anastomosis? An AAST prospective multicenter study J Trauma 50 765–75 Occurrence Handle1:STN:280:DC%2BD3M3ptFehtw%3D%3D Occurrence Handle11371831
LM Flint GC Vitale D Richardson HC Polk (1981) ArticleTitleThe injured colon: relationships of management to complications Ann Surg 193 619–23 Occurrence Handle1:STN:280:Bi6B3cnislc%3D Occurrence Handle7235766
SM George TC Fabian GR Voeller KA Kudsk EC Mangiante LG Britt (1989) ArticleTitlePrimary repair of colon wounds: a prospective trial in nonselected patients Ann Surg 209 728–34 Occurrence Handle2730183
MA Levison DD Thomas RG Wiencek RF Wilson (1990) ArticleTitleManagement of the injured colon: evolving practice at an urban trauma center J Trauma 30 247–53 Occurrence Handle1:STN:280:By%2BC1cbisVM%3D Occurrence Handle2313743
Burch JM, Martin RR, Richardson RJ, Muldowny DS, Mattox KL, Jordan GL. Evolution of the treatment of the injured colon in the 1980s. Am J Surg 1991:979-84.
CW Chappuis DJ Frey CD Dietzen TP Panetta KJ Buechter I Cohn (1991) ArticleTitleManagement of penetrating colon injuries: a prospective randomized trial Ann Surg 213 492–8 Occurrence Handle1:STN:280:By6B387nsF0%3D Occurrence Handle2025069
D Demetriades D Charalambides D Pantanowitz (1992) ArticleTitleGunshot wounds of the colon: role of primary repair Ann R Coll Surg Engl 74 381–4 Occurrence Handle1:STN:280:ByyC3M7ms1U%3D Occurrence Handle1471831
PA Taheri JJ Ferrara CE Johnson KA Lamberson LM Flint (1993) ArticleTitleA convincing case for primary repair of penetrating colon injuries Am J Surg 166 39–44 Occurrence Handle1:STN:280:ByyA3MbgsVE%3D Occurrence Handle8328627
GC Velmahos I Souter E Degiannis C Hatzitheophilou (1996) ArticleTitlePrimary repair for colonic gunshot wounds ANZ J Surg 66 344–7 Occurrence Handle1:STN:280:BymB28bjtlY%3D
N Eshraghi RJ Mullins JC Mayberry DM Brand RA Crass DD Trunkey (1998) ArticleTitleSurveyed opinion of American trauma surgeons in management of colon injuries J Trauma 44 93–7 Occurrence Handle1:STN:280:DyaK1c7isVCjsw%3D%3D Occurrence Handle9464754
M Pasquale TC Fabian (1998) ArticleTitlePractice management guidelines for trauma from the Eastern Association for the Surgery of Trauma J Trauma 44 941–57 Occurrence Handle1:STN:280:DyaK1c3pvFaiug%3D%3D Occurrence Handle9637148
RM Stewart TC Fabian MA Croce FE Pritchard G Minard KA Kudsk (1994) ArticleTitleIs resection with primary anastomosis following destructive colon wounds always safe? Am J Surg 168 316–9 Occurrence Handle1:STN:280:ByqD3s%2FhslE%3D Occurrence Handle7943586
RM Durham C Pruitt J Moran WE Longo (1997) ArticleTitleCivilian colon trauma: factors that predict success by primary repair Dis Colon Rectum 40 685–92 Occurrence Handle1:STN:280:ByiA3sjns10%3D Occurrence Handle9194463
EE Cornwell GC Velmahos TV Berne et al. (1998) ArticleTitleThe fate of colonic suture lines in high-risk trauma patients: a prospective analysis J Am Coll Surg 87 58–63 Occurrence Handle10.1016/S1072-7515(98)00111-2
JA Murray D Demetriades M Colson et al. (1999) ArticleTitleColonic resection in trauma: colostomy versus anastomosis J Trauma 46 250–3 Occurrence Handle1:STN:280:DyaK1M7ltFCrtQ%3D%3D Occurrence Handle10029029
AA Adesanya IR Afolabi JT Rocha-Afodu Particleda (1998) ArticleTitleCivilian abdominal gunshot wounds in Lagos J R Coll Surg Edinb 43 230–4 Occurrence Handle1:STN:280:DyaK1cvgs1Kjtw%3D%3D Occurrence Handle9735644
AA Adesanya JT Rocha-Afodu Particleda EE Ekanem IR Afolabi (2000) ArticleTitleFactors affecting mortality and morbidity in patients with abdominal gunshot wounds Injury 31 397–404 Occurrence Handle1:STN:280:DC%2BD3MrjtFyguw%3D%3D Occurrence Handle10831735
JT Rocha-Afodu ParticleDa (1970) ArticleTitleMilitary and civilian abdominal injuries J Nigerian Med Assoc 7 22–6
TF Solanke O Bademosi SB Olupitan (1970) ArticleTitleExperience with abdominal injuries in the civil war in Nigeria as seen in an evacuation hospital Ghana Med J 9 120–4
DC Nwafor (1980) ArticleTitleSelective primary suture of the battle injured colon: an experience of the Nigerian civil war Br J Surg 67 195–7 Occurrence Handle6988035
BN Baako (1998) ArticleTitleColostomy: its place in the management of colorectal injuries in civilian practice West Afr Med J 17 109–12 Occurrence Handle1:STN:280:DyaK1czotVynuw%3D%3D
EE Moore EL Dunn JB Moore JS Thompson (1981) ArticleTitlePenetrating abdominal trauma index J Trauma 21 439–45 Occurrence Handle1:STN:280:Bi6C1Mvos1U%3D Occurrence Handle7230296
EP Dellinger MR Oreskovich MJ Wertz V Hamasaki ES Lennard (1984) ArticleTitleRisk of infection following laparotomy for penetrating abdominal injury Arch Surg 119 20–7 Occurrence Handle1:STN:280:BiuD2sfpslI%3D Occurrence Handle6689870
NY Kamwendo MC Modiba NS Matlala PJ Becker (2002) ArticleTitleRandomized clinical trial to determine if delay from time of penetrating colonic injury precludes primary repair Br J Surg 89 993–8 Occurrence Handle10.1046/j.1365-2168.2002.02154.x Occurrence Handle1:STN:280:DC%2BD38vgsVeitQ%3D%3D Occurrence Handle12153623
D Demetriades M Lakhoo A Pezikis D Charalambides D Pantanowitz C Sofianos (1991) ArticleTitleShort-course antibiotic prophylaxis in penetrating abdominal injuries: ceftriaxone versus cefoxitin Injury 22 20–4 Occurrence Handle10.1016/0020-1383(91)90154-7 Occurrence Handle1:STN:280:By6B3s7jtlI%3D Occurrence Handle2030024
HA Poret TC Fabian MA Croce RP Bynoe KA Kudsk (1991) ArticleTitleAnalysis of septic morbidity following gunshot wounds to the colon: the missile is an adjuvant for abscess J Trauma 31 1088–94 Occurrence Handle1831510 Occurrence Handle10.1097/00005373-199131080-00007
D Demetriades D Charalambides (1993) ArticleTitleGunshot wounds of the colon: role of retained bullets in sepsis Br J Surg 80 772–3 Occurrence Handle1:STN:280:ByyA387gsFE%3D Occurrence Handle8330174
JD Berne GC Velmahos LS Chan JA Asensio D Demetriades (1998) ArticleTitleThe high morbidity of colostomy closure after trauma: further support for the primary repair of colon injuries Surgery 123 157–64 Occurrence Handle10.1067/msy.1998.84178 Occurrence Handle1:STN:280:DyaK1c7kt1Cjsg%3D%3D Occurrence Handle9481401
MD Fiedler LM Jones SF Miller RK Finley (1986) ArticleTitleA correlation of response time and the results of abdominal gunshot wounds Arch Surg 121 902–4 Occurrence Handle1:STN:280:BimB28fjsFQ%3D Occurrence Handle3729707
ACKNOWLEDGMENTS
The authors thank the consultant general surgeons who allowed us to study their patients and all residents who participated in the management of these patients.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Adesanya, A., Ekanem, E. A Ten-Year Study of Penetrating Injuries of the Colon. Dis Colon Rectum 47, 2169–2177 (2004). https://doi.org/10.1007/s10350-004-0726-5
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10350-004-0726-5