The conundrum of traumatic colon injury

Fealk, Michael; Osipov, Robert; Foster, Kevin; Caruso, Daniel; Kassir, Andrew

doi:10.1016/j.amjsurg.2004.08.057

« Previous Next »The American Journal of Surgery
Volume 188, Issue 6 , Pages 663-670, December 2004

The conundrum of traumatic colon injury

Presented at the 56th Annual Meeting of the Southwestern Surgical Congress, Monterey, California, April 18–21, 2004

Michael Fealk, D.O.
- Department of General Surgery, Maricopa Integrated Health Systems, 2601 E. Roosevelt Avenue, Phoenix, AZ 85008, USA
Robert Osipov, M.D.
- Department of General Surgery, Maricopa Integrated Health Systems, 2601 E. Roosevelt Avenue, Phoenix, AZ 85008, USA
Kevin Foster, M.D. (F.A.C.S.)
- Department of General Surgery, Maricopa Integrated Health Systems, 2601 E. Roosevelt Avenue, Phoenix, AZ 85008, USA
Daniel Caruso, M.D. (F.A.C.S.)
- Department of General Surgery, Maricopa Integrated Health Systems, 2601 E. Roosevelt Avenue, Phoenix, AZ 85008, USA
Andrew Kassir, M.D. (F.A.C.S., F.R.C.S.I., F.A.S.C.R.S.)
- Department of General Surgery, Maricopa Integrated Health Systems, 2601 E. Roosevelt Avenue, Phoenix, AZ 85008, USA
- Corresponding author: Tel.: +1-602-344-5441; fax: +1-602-344-5048.

Received 12 August 2004; received in revised form 12 August 2004

Abstract

Background

Surgical care in the case of traumatic injury to the colon has changed significantly. During World War II, diversion was dictum. Current trends favor primary repair.

Methods

A retrospective chart review of traumatic colon injuries at an urban level 1 trauma center was performed. Multiple data points were collected. Colon-related complications were examined in detail.

Results

Seventy-four charts fulfilled inclusion criteria. The majority of patients were treated with primary repair. The median Colon Injury Scale (CIS) grade was 2, and the average Penetrating Abdominal Trauma Index (PATI) score was 19. Patients repaired by diversion suffered more colon-related complications; however, the difference was not statistically significant.

Conclusions

The emerging dictum for traumatic colon injuries is primary repair. Questions remain as to whether primary repair is the safest option for all colon injuries. The PATI score, CIS grade, and multiple other factors should be included in the decision making algorithm with an emphasis on primary repair.

Keywords: Colon trauma , Primary repair , Diversion