Over the past three decades. primary repair of colonic injuries has become
more accepted and there has been a trend toward using this procedure
for repairing civilian colonic injures. However, the best procedure remains
controversial. Forty patients with colonic injuries alone or
associated with other organ injuries were included in the present study
over a 44 months period Benha University HospitaL After resuscitation.
exploratory laparotorny was done and other organ injuries were appropriately
managed. Colonic injuries were dealt with either by primary repair.
age. blood transfusion. mechanism and site of injury and injury severity
indices. The mechanism of injury was stab injury in 37.596 gunshout in
32.5% iatrogenic in I 7"6 and blunt trauma in 13%. Isolated colon injuries
were found in 27.5% and associated with small intestinal injury in 47%.
The left colon injuries were found in 40% followed by transverse colon in
37.5%. Primary repair either by debridement and simple closure in 2
layers or by segmental resection and primary anastomosis was done in
65% of patients while diversion procedures were carried out for 35% of
patients. There were 3 mortalities (and complications occurred in 30% of
the studied patients.
From this study we can conclude that there is no single policy _for management
of colon injuries either by diversion or primary repair. Good results
can be obtained by proper decision of an experienced surgeon according
to the individual circumstances of each case rather than following
solid scheme by less experienced surge Primary suture should be limited to early cases induced by sharp agents or iatrogenic injury. For most severely
traumatized patients diversion remains the most dependable method
of treatment as it is followed by the least morbidity and mortality. |
